Pre-Hospital and Emergency Department Shock Index Pediatric Age-Adjusted (SIPA) “Cut Points” to Identify Pediatric Trauma Patients at Risk for Massive Transfusion and/or Mortality
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Read the article on jpedsurg.org ↗Article · Oct 2021 · 1 min read
In brief
In brief
This study establishes age-specific SIPA thresholds to predict which injured children need massive transfusion or are at risk of death. The researchers found SIPA cut points work better for adolescents than very young children, with optimal performance in patients over 12 years old for both pre-hospital and ED settings.
Written by the GCMD Library team from the article.
Background
: Shock index pediatric age-adjusted (SIPA) is a validated measure to identify severely injured children. Previous literature categorized SIPA as normal or elevated, but the relationship between specific SIPA values and outcomes has not been determined. We sought to determine specific SIPA cut points in the pre-hospital and Emergency Department (ED) settings to identify patients at risk for massive transfusion (MT) and/or mortality.
Methods
: Patients ≤18 years old admitted to our Level I pediatric trauma center following trauma activation were included. Youdin J index was used to define pre-hospital and ED SIPA cut points to identify those at risk of MT and/or mortality for the following age groups: < 1 year, 1 - 6 years, 7 - 12 years, and > 12 years old. Sensitivity, specificity, accuracy, and area under the curve (AUC) were calculated to determine SIPA threshold values associated with MT and/or mortality.
Results
: Of 1,072 patients, 6.3% (n=68) required MT and 8.4% (n=90) died. For predicting MT, pre-hospital SIPA cut points performed best in the > 12 year-old age group (AUC=0.86) and ED SIPA cut points performed best in the 6–12 year-old age group (AUC=0.87). For predicting mortality, pre-hospital (AUC=0.78) and ED SIPA cut points (AUC=0.84) performed best in the >12 year-old age group.
Conclusion
: Pre-hospital and ED SIPA cut points performed better at predicting MT and/or mortality in older pediatric patients compared to very young children. Age remains an important factor when determining the validity of SIPA to predict outcomes in pediatric trauma patients.