The shock index, pediatric age-adjusted (SIPA) enhanced: Prehospital and emergency department SIPA values forecast transfusion needs for blunt solid organ injured children

Abstract

BackgroundThe elevated shock index, pediatric age-adjusted (SIPA) has been found to accurately predict the need for blood transfusion in severely injured children. We sought to determine the utility of monitoring sequential SIPA values from the prehospital setting through the emergency department to identify children with a blunt liver or spleen injury who will require a blood transfusion. MethodsWe conducted a retrospective review of children 1 to 18 years old admitted to a level-1 pediatric trauma center with any grade blunt liver or spleen injury between 2009 and 2019. Cohorts were stratified into those who received a blood transfusion within the first 24 hours after injury and those who did not. ResultsA total of 477 children had a blunt liver or spleen injury during the study period, of which 20% (95 of 477) received a blood transfusion within 24 hours of trauma center arrival. Of those who received a blood transfusion, 75% (71 of 95) were transfused within 6 hours of arrival at our center. Nearly 90% (84 of 95) of patients who received blood had at least 1 elevated SIPA score in either setting (prehospital or emergency department). Based on multivariable regression, an elevated SIPA score in either setting was significantly associated with blood transfusion (odds ratio 7.8 (confidence interval 4.7–12.9, P = .002). ConclusionElevated SIPA values in the prehospital setting and on emergency department arrival are associated with early blood transfusion. The importance of this finding is that after serial SIPA values may assist in the early identification of children with blunt liver or spleen injury who will require a blood transfusion.