Utilization of Age-Adjusted Shock Index in a Resource-Strained Setting
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In brief
In brief
This comparative study of 1,648 injured children in South Africa and the United States demonstrates that age-adjusted shock index (SIPA) outperforms traditional shock index in predicting mortality, ICU admission, and injury severity, particularly in resource-strained settings. SIPA showed superior discrimination for in-hospital mortality in middle-income countries, suggesting it may be a more effective triage tool where medical resources are limited.
Written by the GCMD Library team from the article.
Background
Identification of injury severity and appropriate triage are critical to effective surgical care, especially where medical and surgical resources are strained. We hypothesized that pediatric age-adjusted shock index (SIPA) would outperform traditional shock index (SI) in a middle-income country (MIC) setting.
Methods
Injured children hospitalized in two trauma centers (South Africa and the United States) from 2012 to 2017 were reviewed. Maximum heart rate and minimum systolic blood pressure defined SI. SI > 0.9 defined elevation. SIPA elevation was based on SI stratified by age: 1–6 years (SI > 1.22), 7–12 years (SI > 1.0), and 13–17 years (SI > 0.9). SI and SIPA were compared using univariate analyses and area under the receiver operating characteristic curves (AUROC).
Results
1648 patients (741 MIC and 907 high-income country (HIC)) were evaluated with a median [IQR] age of 11 [6–15] years. SI was elevated in 377 (51%) MIC children, whereas SIPA was elevated in 248 (34%). In both the HIC and MIC, elevated SIPA was more associated with ISS ≥ 25, ICU admission, and mortality. In MIC patients specifically, elevated SIPA improved discrimination for in-hospital mortality (AUROC 0.66 vs AUROC 0.57, p