Elevated pediatric age-adjusted shock-index (SIPA) in blunt solid organ injuries
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In brief
In brief
Study of 3,561 pediatric patients demonstrates that elevated Shock Index Pediatric-Adjusted (SIPA) scores in pre-hospital or emergency department settings accurately predict which children with blunt liver or spleen injuries will require blood transfusion or surgical intervention, with 8-fold increased odds for transfusion need.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose
Shock index-pediatric age-adjusted (SIPA) is a proven tool to predict outcomes in blunt pediatric trauma. We hypothesized that an elevated SIPA in either the pre-hospital or in the emergency department (ED) would identify children with blunt liver or spleen injury (BLSI) needing a blood transfusion and those at risk for failure of non-operative management (NOM).
Methods
Pediatric patients (1–18 years) in the ACS pediatric-TQIP database (2014–2016) with a BLSI were included. Patients were stratified by the need for a blood transfusion and/or abdominal operation.
Results
A total of 3561 patients had BLSI, of which 4% received a blood transfusion, and 4% underwent an abdominal operation. Patients who received blood had higher ISS scores (27.0 vs. 5.0, p < 0.001) and mortality (22% vs. 0.4%, p < 0.001). Those who failed NOM had higher ISS scores (17.0 vs. 5.0, p < 0.001) and mortality (7.9% vs. 0.9%, p < 0.001). On multivariable regression, an elevated SIPA score in either pre-hospital or ED was significantly associated with blood transfusion (odds ratio (OR) 8.2, 95% confidence intervals (CI) 5.8–11.5, p < 0.001) and failure of NOM (OR 2.3, CI 1.5–3.4, p < 0.001).
Conclusions
Hemodynamic instability, represented by an elevated pre-hospital or ED SIPA, accurately identifies children with BLSI who may need blood products or an operative intervention.
Type of Study
Retrospective Comparative Study.
Level of Evidence
Level III.