The shock index among children presenting to the emergency department: analysis of a nationally-representative sample

Abstract

BackgroundThe Shock Index (SI) is emerging as a potentially useful measure among children with injury or with suspected sepsis. ObjectiveTo evaluate the distribution of the SI and evaluate its association with clinical outcomes among all children presenting to the emergency department (ED). MethodsWe analyzed a complex survey of nonfederal US ED encounters from 2016-2021. Among children, we evaluated the Pediatric Age-Adjusted Shock Index (SIPA), Pediatric SI (PSI), and the Temperature- and Age-Adjusted Shock Index (TAMSI). We evaluated the association of each criteria with disposition, acuity, medication administration, diagnoses and procedures. ResultsWe included a survey-weighted 81.5 million ED visits for children 4-16 years old and 117.2 million visits for children 1-12 years old. SI could be calculated for 78.6% of patients 4-16 years and 57.9% of patients 1-12 years old. An abnormal SI was present in 15.9%. 11.1%, and 31.7% when using the SIPA, PSI, and TAMSI, respectively. With all criteria, an elevated SI was associated with greater hospitalization. The SIPA and PSA were associated with triage acuity. All criteria were associated with medical interventions including provision of intravenous fluids and acquisition of blood cultures. ConclusionsAn elevated SI indicative of greater resource utilization needs among children in the ED. When using either criterion, an elevated SI was associated with clinically important outcomes. Further research is required to evaluate the distribution of the SI in children and to investigate its potential role within existing triage algorithms for children in the ED.