2022
DOI: 10.1016/j.jpedsurg.2021.09.053
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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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Cited by 15 publications
(29 citation statements)
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“…Several triage tools have been developed to address the limitations of using hypotension for recognizing hemorrhagic shock in children and adults. Adult triage tools have used a range of input variables, including vital signs alone (shock index, reverse shock index), vital signs and GCS (rSIG), vital signs, injury type, and abdominal ultrasound findings (ABC score), and age, vital signs, body region injured, ultrasound findings, and laboratory findings (Trauma Bleeding Severity Score) 11–14,33–35 . To be applicable to children, adult triage scores have been modified to include age-based vital sign thresholds.…”
Section: Discussionmentioning
confidence: 99%
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“…Several triage tools have been developed to address the limitations of using hypotension for recognizing hemorrhagic shock in children and adults. Adult triage tools have used a range of input variables, including vital signs alone (shock index, reverse shock index), vital signs and GCS (rSIG), vital signs, injury type, and abdominal ultrasound findings (ABC score), and age, vital signs, body region injured, ultrasound findings, and laboratory findings (Trauma Bleeding Severity Score) 11–14,33–35 . To be applicable to children, adult triage scores have been modified to include age-based vital sign thresholds.…”
Section: Discussionmentioning
confidence: 99%
“…Because SIPA and rSIG thresholds for four-hour blood transfusion were selected based upon a value that maximized both sensitivity and specificity, we used this method to select a probability threshold using probabilities from the training data set. [12][13][14] We compared the sensitivity, specificity, and accuracy of TRAIN with SIPA and rSIG using 2019 validation data. Because blood transfusion is uncommon after pediatric injury, the 2 Â 2 confusion matrix used to generate these metrics is imbalanced, with a high representation of negative cases (i.e., not transfused).…”
Section: Model Selection and Validationmentioning
confidence: 99%
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“…35 To account for the variability in vital signs by age, several adult triage tools have been modified for use in children, including the pediatric versions of shock index (SIPA), reverse shock index with Glasgow Coma Scale (rSIG), and the ABC score. [40][41][42][43] Although initial studies suggest that these tools are more accurate than the use of single components of these scores, their performance has only been evaluated retrospectively, and their predictive performance and impact on timeliness of intervention have not been compared with clinical judgment alone. Development and implementation of these tools in clinical practice have had several challenges, some unique to application for injured children and others common to triage tools used for all ages.…”
Section: The Transfusion Process: Decide Dispense and Deliver Decisio...mentioning
confidence: 99%
“…13,38,[41][42][43] Third, several scores, such as SIPA and rSIG, function as binary predictors (present/absent need for transfusion) and do not yield a probability or risk estimate like some adult tools. [41][42][43] Because interventions for hemorrhage may be chosen using a cost-effectiveness standard or differ based on risk of hemorrhage, binary classification may limit the applicability of these tools. Fourth, tools like the pediatric version of the ABC score require laboratory and imaging results that are often not available before patient arrival or early after arrival to the hospital.…”
Section: The Transfusion Process: Decide Dispense and Deliver Decisio...mentioning
confidence: 99%