Establishing thresholds for shock index in children to identify major trauma.

Autor: Ramgopal S; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. Electronic address: sramgopal@luriechildrens.org., Gorski JK; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Chaudhari PP; Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles CA, USA., Spurrier RG; Division of Pediatric Surgery, Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, USA., Horvat CM; Division of Pediatric Critical Care Medicine, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA., Macy ML; Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA., Cash RE; Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA., Stey AM; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA., Martin-Gill C; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Jazyk: angličtina
Zdroj: Injury [Injury] 2024 Aug 23, pp. 111840. Date of Electronic Publication: 2024 Aug 23.
DOI: 10.1016/j.injury.2024.111840
Abstrakt: Background: An abnormal shock index (SI) is associated with greater injury severity among children with trauma. We sought to empirically-derive age-adjusted SI cutpoints associated with major trauma in children, and to compare the accuracy of these cutpoints to existing criteria for pediatric SI.
Methods: We performed a retrospective cohort study using the 2021 National Trauma Data Bank (NTDB) Participant Use File. We included injured children (<18 years), excluding patients with traumatic arrests, mechanical ventilation upon hospital presentation, and inter-facility transfers. Our outcome was major trauma defined by the standardized triage assessment tool (STAT) criteria. Our exposure of interest was the SI. We empirically-derived upper and lower cutpoints for the SI using age-adjusted Z-scores. We compared the performance of these to the SI, pediatric-adjusted (SIPA), and the Pediatric SI (PSI). We validated the performance of the cutpoints in the 2019 NTDB.
Results: We included 64,326 and 64,316 children in the derivation and validation samples, of whom 4.9 % (derivation) and 4.0 % (validation) experienced major trauma. The empirically-derived age-adjusted SI cutpoints had a sensitivity of 43.2 % and a specificity of 79.4 % for major trauma in the validation sample. The sensitivity of the PSI for major trauma was 33.9 %, with a specificity of 90.7 % among children 1-17 years of age. The sensitivity of the SIPA was 37.4 %, with a specificity of 87.8 % among children 4-16 years of age. Evaluated using logistic regression, patients with an elevated age-adjusted SI had 3.97 greater odds (95 % confidence interval [CI] 3.63-4.33) of major trauma compared to those with a normal age-adjusted SI. Patients with a depressed SI had 1.55 greater odds (95 % CI 1.36-1.78) of major trauma. The area under the receiver operator characteristic curve (AUROC) for the empirically-derived model (0.62, 95 % CI 0.61-0.63) was similar to the AUROC for PSI (0.62, 95 % CI 0.61-0.63); both of which were greater than the SIPA model (0.58, 95 % CI 0.57-0.59).
Conclusion: Age-adjusted SI cutpoints demonstrated a mild gain in sensitivity compared to existing measures. However, our findings suggest that the SI alone has a limited role in the identification of major trauma in children.
Competing Interests: Declaration of competing interest None
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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