Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study.
Document Type
Article
Publication Date
2-1-2017
Identifier
DOI: 10.1016/j.jpedsurg.2016.09.060
Abstract
BACKGROUND: Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity.
METHODS: A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI).
RESULTS: Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group.
CONCLUSION: SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI.
LEVEL OF EVIDENCE: Level II prognosis.
Journal Title
Journal of pediatric surgery
Volume
52
Issue
2
First Page
340
Last Page
344
MeSH Keywords
Adolescent; Blood Transfusion; Child; Child, Preschool; Emergency Service, Hospital; Female; Health Status Indicators; Hospitalization; Humans; Injury Severity Score; Liver; Male; Prognosis; Prospective Studies; Retrospective Studies; Shock, Traumatic; Spleen; Wounds, Nonpenetrating
Keywords
SIPA; Shock index pediartic-adjusted; Shock index; Trauma injury; Blood Transfusion
Recommended Citation
Linnaus ME, Notrica DM, Langlais CS, et al. Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. J Pediatr Surg. 2017;52(2):340-344. doi:10.1016/j.jpedsurg.2016.09.060
Comments
LEVEL OF EVIDENCE:
Level II prognosis.