Trends in pediatric-adjusted shock index predict morbidity in children with moderate blunt injuries

Abstract

PURPOSE: Trending the pediatric-adjusted shock index (SIPA) after admission has been described for children suffering severe blunt injuries (i.e. injury severity score (ISS)>15). We propose that following SIPA in children with moderate blunt injuries, as defined by ISS 10-14, has similar utility. METHODS: The trauma registry at a single institution was queried over a seven year period. Patients were included if they were between 4-16 years old at the time of admission, sustained a blunt injury with an ISS 10-14, and were admitted less than 12 hours after their injury (n=501). Each patient's SIPA was then calculated at 0, 12, 24, 36, and 48 hours (h) after admission and then categorized as elevated or normal at each time frame based upon previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed. RESULTS: In patients with a normal SIPA at arrival, elevation within the first 24h of admission correlated with increased length of stay (LOS). Increased transfusion requirement, incidence of infectious complications, and need for in-patient rehabilitation were also seen in analyzed subgroups. An elevated SIPA at arrival with increased length of time to normalize SIPA correlated with increased length of stay LOS in the entire cohort and in those without head injury, but not in patients with a head injury. No deaths occurred within the study cohort. CONCLUSIONS: Patients with an ISS 10-14 and a normal SIPA at time of arrival who then have an elevated SIPA in the first 24h of admission are at increased risk for morbidity including longer LOS and infectious complications. Similarly, time to normalize an elevated admission SIPA appears to directly correlate with LOS in patients without head injuries. No correlations with markers for morbidity could be identified in patients with a head injury and an elevated SIPA at arrival. This may be due to small sample size, as there were no relations to severity of head injury as measured by Head Abbreviated Injury Scale (Head AIS) and the outcome variables reported. This is an area of ongoing analysis. This study extends the previously reported utility of following SIPA after admission into milder blunt injuries

Pediatric trauma: Blood product transfusion characteristics in a pediatric emergency department, a single center experience

“…The SIPA was reported to have a correlation with ISS, ventilator use, length of hospital stay, early need for blood product transfusion, and mortality in pediatric trauma patients [15,28,29]. In our study population, the SIPA was not correlated with the ISS, need for MT, or outcomes, but among the patients with non-severe TBI, those who did not survive had higher initial SIPA values.…”

“…This may be related to the fact that most of our patients had severe TBI, so the reason may be that the associated hypertension and/or bradycardia commonly present in patients with severe TBI could alter SIPA values. It was reported that in cases of head trauma, SIPA elevation upon arrival was correlated with a longer stay in the hospital [28]. However, we could not perform serial measurements of SIPA due to the retrospective nature of our study.…”

Shock index and shock index, pediatric age-adjusted as predictors of mortality in pediatric patients with trauma: A systematic review and meta-analysis

“…They found that patients with severe blunt injuries initially presenting with a normal SIPA, but later developing a positive SIPA within 24 hours, had a higher mortality rate compared to those with consistently normal SIPA within the first 48 hours of admission [ 19 ]. Similarly, patients with moderate blunt injuries, initially presenting with a normal SIPA upon arrival, but subsequently developing a positive SIPA within 24 hours, were associated with an increased length of stay and the need for transfusion within the first 24 hours of arrival [ 38 ]. Moreover, Marenco et al [ 21 ] reviewed the Department of Defense Trauma Registry for pediatric patients with warzone trauma (age ≤ 17 years) and found that patients with a positive SIPA at both pre-hospital and arrival to initial care showed increased incidence of intensive care unit (ICU) admission, mechanical ventilation requirement, and mortality.…”