The Role of Trending Shock Index Paediatric Adjusted (SIPA) in Paediatric Trauma as a Predictor of Morbidity and Mortality

Abstract

Abstract Background and Purpose There are several injury scoring systems, anatomic, physiologic and combined scores, which have been used for prediction of patients' outcome such as mortality. Among physiologic scoring systems evolved shock index (heart rate divided by systolic blood pressure) which has been first described in 1967. In the world of paediatric and due to the physiological differences between different age groups, few adjustments have to be done considering these changes evolving shock index paediatric adjusted (SIPA). This study was conducted to evaluate SIPA as a quick feasible method for triaging and managing pediatric trauma and also to predict ICU admission and need for CT scan as a primary outcome and also secondary outcomes like length of hospital stay and (need for surgical intervention) and mortality rate. Study Design Prospective randomized controlled study. Setting The children’s accident and emergency department in Armed Forces Hospitals and Ain Shams University hospitals. Subjects We included 124 pediatric trauma children, and they were divided into 2 groups: Group A (62 children): assessed by SIPA in an incidence of trauma, and Group B (62 children): assessed by traditional vital signs (blood pressure, pulse and capillary refill). Methods All patients were subjected to full history taking, SIPA assessment on admission and its daily changes (baseline up to 48 hours). Assessment for need for ICU admission, ventilation, CT scan, surgical intervention, and Length of hospital stay, along with mortality rate recording. Results In the studied population, the mean age of all patients was (6.8 ± 3.2) years, with (65.3%) of patient males; and (34.7%) females. Regarding outcome data, comparative study between the 2 groups revealed; significant decrease in ICU admission, need for CT scan, LOS and mortality rate in Group A (SIPA) (p < 0.05). As regards SIPA trend, we found non-significant difference between mortality and no-mortality subgroups in SBP, heart rate, Capillary refill time and SIPA during the serial (baseline up to 48-h) measurements. Also, regarding ICU LOS, we found non-significant difference between mortality and no-mortality subgroups in SBP, heart rate, Capillary refill time and SIPA during the serial (baseline up to 48-h) measurements. Conclusion To conclude, SIPA score proven to be an accurate and specific predictor of morbidity, hospital stay and ICU admission, and mortality rate in pediatric trauma patients and is superior to capillary refill time, tachycardia or hypotension alone for predicting different outcomes.