Addition of Neurological Status to Pediatric Adjusted Shock Index to Predict Early Mortality in Trauma: A Pediatric TQIP Analysis.
Pediatric adjusted shock index (SIPA) has demonstrated the ability to prospectively identify children at the highest risk for early mortality. The addition of neurological status to shock index has shown promise as a reliable triage tool in adult trauma populations. This study sought to assess the utility of combining SIPA with Glasgow Coma Scale (GCS) for predicting early trauma related outcomes.Retrospective review of the 2017 Trauma Quality Improvement Program Database was performed for all severely injured patients less than 18 years old. SIPA and reverse SIPA x GCS (rSIG) were calculated. Age-specific cut off values were derived for rSIG and compared to their SIPA counterparts for early mortality assessment using area under the receiver operator characteristic (AUROC) curve analyses.10,389 pediatric patients with an average age of 11.4 years old, 67% male, average ISS 24.1, and 4% sustaining a major penetrating injury were included in the analysis. The overall mortality was 9.3%. 32.1% of patients displayed an elevated SIPA score while only 27.5% displayed a positive rSIG. On AUROC analysis, rSIG was found to be superior to SIPA as a predictor for in hospital mortality with values of 0.854 versus 0.628, respectively.rSIG more readily predicted in hospital mortality for pediatric trauma patients when compared to SIPA. These findings suggest neurological status should be an important factor during initial patient assessment. Further study to assess the applicability of rSIG for expanded trauma related outcomes in pediatric trauma is necessary.Level IV.
Authors: Daniel T Lammers, Christopher W Marenco, Kaitlin R Morte, Jeffrey R Conner, John D Horton, Meade Barlow, Matthew J Martin, Jason R Bingham, Matthew J Eckert, Mauricio A Escobar