Validation of Shock Index Pediatric-Adjusted (SIPA) for Children Injured in Warzones.
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In brief
In brief
Study validates Shock Index Pediatric-Adjusted (SIPA) as an effective triage tool for children injured in combat zones, demonstrating its ability to predict need for blood transfusion and emergency surgery. Analysis of 2,121 warzone pediatric trauma cases shows elevated SIPA correlates with doubled transfusion rates and significantly higher mortality.
Written by the GCMD Library team from the article.
BACKGROUND:
Shock Index Pediatric-Adjusted (SIPA) has been used to predict injury severity and outcomes after civilian pediatric trauma. We hypothesize that SIPA can predict the need for blood transfusion and emergent surgery among pediatric patients injured in warzones, where resources are limited and accurate triage is essential.
METHODS:
Retrospective review of the DoD Trauma Registry for all patients ≤17years, from 2008-2015. SIPA was determined using vital signs recorded upon arrival to the initial level of care. Patients were classified into two groups (normal v. elevated SIPA) using age-specific threshold values. Need for blood product transfusion (BPT) within 24 hours and emergent surgical procedures (ESP) was compared between groups. ICU admission, injury severity, and mortality were also compared. Regression analysis was performed to evaluate the relationship between SIPA and primary outcomes.
RESULTS:
2121 patients were included with mean ISS 12±10. The mechanism of injury was penetrating (63%), blunt (25%), and burns (12%). Patients with an elevated SIPA (43%) had significantly greater need for BPT (49.2% v. 25.0%) and ESP (22.9% v. 16.0%), as well as mortality (10.3% v. 4.8%) and ICU admission (49.9% v. 36.1%), all p