Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

• Published in: Archives of disease in childhood 2022-02, Vol.107 (2), p.116-122
• Main Authors: Hagedoorn, Nienke N, Zachariasse, Joany M, Borensztajn, Dorine, Adriaansens, Elise, von Both, Ulrich, Carrol, Enitan D, Eleftheriou, Irini, Emonts, Marieke, van der Flier, Michiel, de Groot, Ronald, Herberg, Jethro Adam, Kohlmaier, Benno, Lim, Emma, Maconochie, Ian, Martinón-Torres, Federico, Nijman, Ruud Gerard, Pokorn, Marko, Rivero-Calle, Irene, Tsolia, Maria, Zavadska, Dace, Zenz, Werner, Levin, Michael, Vermont, Clementien, Moll, Henriette A
• Format: Article
• Language: English
• Subjects: Age groups; Anatomy; Bacterial diseases; Bacterial infections; Blood Pressure; Child; Child, Preschool; Children; Climate; Communicable Diseases; Comorbidity; Data Analysis; Departments; Emergency medical care; Emergency Service, Hospital; epidemiology; Female; Fever; Fever - diagnosis; Fever - etiology; Fever - pathology; Flow Charts; Heart Rate; Hospitals; Humans; Illnesses; Infections; Logistic Models; Male; Medical Services; Observational studies; Original Research; Ostomy; Outcome Measures; Patients; Pediatrics; physiology; Prospective Studies; Reference Values; Referral; Risk Assessment; Shock; Shock (Circulatory); Shock - diagnosis; Shock - pathology; Teaching Methods; Trauma; Vital signs
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2020-320992

Objective(1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children.Design/settingObservational study in 11 European EDs (2017–2018).PatientsFebrile children with measured blood pressure.Main outcome measuresSerious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs).ResultsOf 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8.ConclusionsHigh Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.