Predicting severe outcomes in pediatric trauma patients: Shock index pediatric age-adjusted vs. age-adjusted tachycardia

• Published in: The American journal of emergency medicine 2024-09, Vol.83, p.59-63
• Main Authors: Sheff, Zachary T., Zaheer, Meesam M., Sinclair, Melanie C., Engbrecht, Brett W.
• Format: Article
• Language: English
• Subjects: Accuracy; Adolescent; Age; Blood pressure; Blood transfusion; Blood transfusions; Cardiac arrhythmia; Child; Child, Preschool; Contingency tables; Cross-Sectional Studies; Emergency department; Emergency medical care; Emergency medical services; Emergency medicine; Emergency Service, Hospital; Female; Glasgow Coma Scale; Heart rate; Humans; Hypotension; Injury Severity Score; Intervention; Liver; Male; Mortality; Ostomy; Patients; Pediatric trauma; Pediatrics; Quality control; Retrospective Studies; Shock - diagnosis; Shock - mortality; Shock index; Spleen; Surgeons; Tachycardia; Tachycardia - diagnosis; Transfusion; Trauma; Trauma centers; Traumatic brain injury; Triage; Triage - methods; Ventilators; Wounds and Injuries - complications; Wounds and Injuries - mortality; Wounds and Injuries - therapy; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - therapy
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2024.06.041

When an injured patient arrives in the Emergency Department (ED), timely and appropriate care is crucial. Shock Index Pediatric Age-Adjusted (SIPA) has been shown to accurately identify pediatric patients in need of emergency interventions. However, no study has evaluated SIPA against age-adjusted tachycardia (AT). This study aims to compare SIPA with AT in predicting outcomes such as mortality, severe injury, and the need for emergent intervention in pediatric trauma patients. This is a retrospective cross-sectional analysis of patient data abstracted from the Trauma Quality Improvement Program Participant Use Files (TQIP PUFs) for years 2013–2020. Patients aged 4–16 with blunt mechanism of injury and injury severity score (ISS) > 15 were included. 36,517 children met this criteria. Sensitivity, specificity, overtriage, and undertriage rates were calculated to compare the effectiveness of AT and elevated SIPA as predictors of severe injuries and need for emergent intervention. Emergent interventions included craniotomy, endotracheal intubation, thoracotomy, laparotomy, or chest tube placement within 24 h of arrival. AT classified 59% of patients as “high risk,” while elevated SIPA identified 26%. Compared to AT patients, a greater proportion of patients with elevated SIPA required a blood transfusion within 24 h (22% vs. 12%, respectively; p