Elevated pediatric age-adjusted shock-index (SIPA) in blunt solid organ injuries

Abstract

Background/PurposeShock index-pediatric age-adjusted (SIPA) is a proven tool to predict outcomes in blunt pediatric trauma. We hypothesized that an elevated SIPA in either the pre-hospital or in the emergency department (ED) would identify children with blunt liver or spleen injury (BLSI) needing a blood transfusion and those at risk for failure of non-operative management (NOM). MethodsPediatric patients (1–18 years) in the ACS pediatric-TQIP database (2014–2016) with a BLSI were included. Patients were stratified by the need for a blood transfusion and/or abdominal operation. ResultsA total of 3561 patients had BLSI, of which 4% received a blood transfusion, and 4% underwent an abdominal operation. Patients who received blood had higher ISS scores (27.0 vs. 5.0, p < 0.001) and mortality (22% vs. 0.4%, p < 0.001). Those who failed NOM had higher ISS scores (17.0 vs. 5.0, p < 0.001) and mortality (7.9% vs. 0.9%, p < 0.001). On multivariable regression, an elevated SIPA score in either pre-hospital or ED was significantly associated with blood transfusion (odds ratio (OR) 8.2, 95% confidence intervals (CI) 5.8–11.5, p < 0.001) and failure of NOM (OR 2.3, CI 1.5–3.4, p < 0.001). ConclusionsHemodynamic instability, represented by an elevated pre-hospital or ED SIPA, accurately identifies children with BLSI who may need blood products or an operative intervention. Type of StudyRetrospective Comparative Study. Level of EvidenceLevel III.