Elevated pediatric age-adjusted shock-index (SIPA) in blunt solid organ injuries
| Autor: | Marina L Reppucci, John Recicar, Gabrielle Shirek, Niti Shahi, Shannon N. Acker, Maxene Meier, Ryan Phillips, Steven L. Moulton, Denis D. Bensard |
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| Rok vydání: | 2021 |
| Předmět: |
Blood transfusion
medicine.medical_treatment Abdominal Injuries Wounds Nonpenetrating 03 medical and health sciences Injury Severity Score 0302 clinical medicine Blunt 030225 pediatrics medicine Humans Child Retrospective Studies business.industry Shock Pediatric age General Medicine Emergency department medicine.disease Shock index Liver 030220 oncology & carcinogenesis Anesthesia Shock (circulatory) Pediatrics Perinatology and Child Health Surgery Level iii medicine.symptom Emergency Service Hospital business Pediatric trauma |
| Zdroj: | Journal of Pediatric Surgery. 56:401-404 |
| ISSN: | 0022-3468 |
| Popis: | Shock index-pediatric age-adjusted (SIPA) is a proven tool to predict outcomes in blunt pediatric trauma. We hypothesized that an elevated SIPA in either the pre-hospital or in the emergency department (ED) would identify children with blunt liver or spleen injury (BLSI) needing a blood transfusion and those at risk for failure of non-operative management (NOM).Pediatric patients (1-18 years) in the ACS pediatric-TQIP database (2014-2016) with a BLSI were included. Patients were stratified by the need for a blood transfusion and/or abdominal operation.A total of 3561 patients had BLSI, of which 4% received a blood transfusion, and 4% underwent an abdominal operation. Patients who received blood had higher ISS scores (27.0 vs. 5.0, p 0.001) and mortality (22% vs. 0.4%, p 0.001). Those who failed NOM had higher ISS scores (17.0 vs. 5.0, p 0.001) and mortality (7.9% vs. 0.9%, p 0.001). On multivariable regression, an elevated SIPA score in either pre-hospital or ED was significantly associated with blood transfusion (odds ratio (OR) 8.2, 95% confidence intervals (CI) 5.8-11.5, p 0.001) and failure of NOM (OR 2.3, CI 1.5-3.4, p 0.001).Hemodynamic instability, represented by an elevated pre-hospital or ED SIPA, accurately identifies children with BLSI who may need blood products or an operative intervention.Retrospective Comparative Study.Level III. |
| Databáze: | OpenAIRE |
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