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Validation Of Shock Index Pediatric-Adjusted (SIPA) For Children Injured In Warzones
*Christopher W Marenco1, Woo Do1, Daniel T Lammers1, John D Horton1, *Kenneth Azarow2, Matthew J Eckert1
1Madigan Army Medical Center, Tacoma, WA;2Oregon Health And Science University Doernbecher Children's Hospital, Portland, OR

Background:
Shock Index Pediatric-Adjusted (SIPA) has been used to predict injury severity and outcomes after civilian pediatric trauma.1 We sought to determine the utility of SIPA for the evaluation of pediatric patients injured in warzones, where resources are limited and accurate triage is essential.
Methods:
Retrospective review of the DoD Trauma Registry for all patients ≤17years, from 2008-2015. SIPA was determined using vital signs recorded upon arrival to the initial level of care. Patients were classified into two groups (normal v. elevated SIPA) using age-specific threshold values.2 Need for blood product transfusion (BPT) within 24 hours and emergent surgical procedures (ESP) was compared between groups. ICU admission, injury severity, and mortality were also compared. Regression analysis was performed to evaluate the relationship between SIPA and primary outcomes.
Results:
2143 patients were included with mean ISS 1210. The mechanisms of injury included penetrating (63%), blunt (25%), and burns (12%). Patients with an elevated SIPA (43%) had significantly greater need for BPT and ESP as well as mortality and ICU admission (Fig.1). Regression analysis confirmed an elevated SIPA as independently associated with both BPT and ESP.
Conclusion:
This is the first study of SIPA in pediatric warzone trauma. Elevated SIPA is associated with significantly increased need for transfusion and emergent surgery, and may therefore serve as a valuable tool for planning and triage in austere settings.


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