Highlights
- •We evaluate the Pediatric age-adjusted shock index (SIPA) for the first time in Australia
- •The First SIPA study to include pediatric trauma patients of all severity and ages shows that it loses correlation in the generalised population
- •SIPA in combination with GCS (SIPAms) on arrival predicts morbidity outcomes more strongly than pre-arrival, but both predict more outcomes than SIPA without GCS.
- •SIPAms increases sensitivity significantly for predictors of morbidity with a mild loss of specificity. aSIPAms has a sensitivity of 76% and specificity of 70% for major trauma.
Abstract
Background
Paediatric age-adjusted shock index (SIPA) has emerged as a predictor of morbidity
and mortality in trauma. Poor sensitivity and low generalisability demonstrated in
previous studies have limited its use. We evaluate the use of SIPA in the general
Australian paediatric trauma population and the combination of SIPA with GCS.
Methods
All patients from January 2015 to August 2020 at a major Australian paediatric trauma
centre were reviewed. Pre-arrival SIPA (pSIPA) and arrival SIPA (aSIPA) were calculated.
If SIPA was elevated or the Glasgow Coma Scale ≤ 13, SIPA with mental state (SIPAms)
was marked positive for pre-arrival (pSIPAms) and arrival (aSIPAms) respectively.
Results/Discussion
Data from 480 patients were analysed. pSIPA and aSIPA poorly predicted outcomes of
morbidity. Only aSIPA predicted mortality. However, both pre-arrival and arrival SIPAms
variables predict mortality, major trauma (ISS≥12), hospital LOS, need for ICU admission,
and major surgery. Furthermore, median ISS and lactate were significantly higher in
positive pSIPA, aSIPA, pSIPAms, and aSIPAms groups than negative. aSIPAms has a sensitivity
of 76% and specificity of 70% for major trauma.
Conclusion
Broad inclusion criteria reduce SIPA's ability to predict morbidity. Combining it
with GCS improves this and is most valuable when calculated at arrival. In addition,
the score is more reliable for major trauma (ISS≥12). Future studies should evaluate
the use of SIPAms in activation criteria.
Keywords
Abbreviations:
aSIPA (Shock Index, Pediatric age-adjusted, calculated on arrival), aSIPAms (Shock Index, Pediatric age-adjusted, with mental state, calculated on arrival), GCS (Glasgow Coma Scale), GCS-M (Motor component of Glasgow Coma Scale), HR (Heart Rate), ICU (Intensive Care Unit), ISS (Injury Severity Score), LOS (Length of Stay), pSIPA (Shock Index, Pediatric age-adjusted, calculated pre-arrival), pSIPAms (Shock Index, Pediatric age-adjusted, with mental state, calculated pre-arrival), SBP (Systolic Blood Pressure), SI (Shock Index), SIPA (Shock Index, Pediatric age-adjusted), SIPAms (Shock Index, Pediatric age-adjusted, with mental state)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 20, 2022
Accepted:
January 18,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Ltd. All rights reserved.
