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J Pediatr Surg. 2019 Oct 24. pii: S0022-3468(19)30684-0. doi: 10.1016/j.jpedsurg.2019.09.032. [Epub ahead of print]

Predictive Value of the Shock Index (SI) Compared to the Age-Adjusted Pediatric Shock Index (SIPA) for Identifying Children that Needed the Highest-Level Trauma Activation Based on the Presence of Consensus Criteria.

Author information

1
Phoenix Children's Hospital, Department of Emergency Medicine. Electronic address: ggandhi@phoenixchildrens.com.
2
Phoenix Children's Hospital, Department of Emergency Medicine. Electronic address: mclaiborne@phoenixchildrens.com.
3
Children's Hospital, New Orleans, Department of Emergency Medicine. Electronic address: Tonig.doctort@gmail.com.
4
Phoenix Children's Hospital, Trauma Department. Electronic address: bsussman@phoenixchildrens.com.
5
Phoenix Children's Hospital, Department of Trauma & Surgery. Electronic address: Kdavenport1@phoenixchildrens.com.
6
Phoenix Children's Hospital, Department of Trauma & Surgery. Electronic address: dostlie@phoenixchildrens.com.
7
Phoenix Children's Hospital, Department of Emergency Medicine. Electronic address: bbulloch@phoenixchildrens.com.

Abstract

OBJECTIVES:

In previous studies, SIPA was shown to be better than the SI in identifying children who have an elevated ISS, required transfusion, or were at a high risk of death. No comparison has been made to the consensus-based criteria that identify patients requiring the highest-level trauma activation. The objective of this study was to determine if the SIPA was more accurate than the SI in identifying children with increased need for trauma team activation as defined by the criterion standard definition, and secondly the sensitivity and specificity of the SI and SIPA.

METHODS:

Retrospective review of prospectively collected trauma based data. Children aged 1-17 years admitted to a pediatric level 1 trauma center between 1/1/16 and 12/31/17 and met the prehospital criteria for level 1 or 2 trauma activation were included. We evaluated the ability of SI > 0.9 at ED presentation and elevated SIPA to predict need for trauma activation based on consensus criteria. SIPA cutoffs were > 1.22 (age 4-6), >1.0 (age 7-12), and > 0.9 (age 13-17).

RESULTS:

Among 3378 children, 1486 (44%) had an elevated SI and 590 (18%) had an elevated SIPA. There were 160 (5%) patients who met at least one consensus criterion. Broadly, sensitivity and specificity analyses reveal poor sensitivity for both SI and SIPA (59.4% versus 43.1% respectively) measures but a moderate specificity for SIPA (83.8%). Both SI and SIPA have a poor PPV (6.4% versus 11.7%) but high NPV (96.6% versus 96.7%). Overall, SIPA has higher accuracy than SI in predicting consensus criteria 82% versus 57%).

CONCLUSION:

SIPA is more accurate than the SI in identifying children who meet a consensus criterion defining the need for highest-level trauma activation. The low PPV and sensitivity suggest that SIPA alone, while somewhat less likely to lead to overtriage than SI is not ideal for ruling in the need for level one resources as defined by the consensus criteria. Prognosis study, retrospective.

LEVEL OF EVIDENCE:

Level II.

KEYWORDS:

Pediatric; Shock index; Trauma

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