Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC + study

• Published in: Journal of pediatric surgery Vol. 52; no. 2; pp. 340 - 344
• Main Authors: Linnaus, Maria E, Notrica, David M, Langlais, Crystal S, St. Peter, Shawn D, Leys, Charles M, Ostlie, Daniel J, Maxson, R Todd, Ponsky, Todd, Tuggle, David W, Eubanks, James W, Bhatia, Amina, Alder, Adam C, Greenwell, Cynthia, Garcia, Nilda M, Lawson, Karla A, Motghare, Prasenjeet, Letton, Robert W
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2017
• Subjects: Adolescent; Blood Transfusion; Child; Child, Preschool; Emergency Service, Hospital; Female; Health Status Indicators; Hospitalization; Humans; Injury; Injury Severity Score; Liver - injuries; Male; Pediatric; Pediatrics; Prognosis; Prospective Studies; Retrospective Studies; Shock index; Shock, Traumatic - diagnosis; Shock, Traumatic - etiology; Shock, Traumatic - therapy; SIPA; Spleen - injuries; Surgery; Trauma; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - therapy; SIPA; Shock index; Pediatric; Trauma; Injury
• ISSN: 0022-3468; 1531-5037
• 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 4–16 years 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 13–16 year-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 h (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.