Shock Index, Pediatric-Adjusted (SIPA) Does Not Predict The Trauma Activation When Using The Consensus Definition
Alexander T Gibbons, *Hali Ramsey, *Heather Schober, *Avraham Schlager
Akron Children's Hospital, Akron, OH
Background: Shock index, pediatric-adjusted (SIPA) is an easily calculated metric that has been shown to better predict the need for blood transfusion, emergency operation, and endotracheal intubation within 24 hours of admission than age-adjusted hypotension. However, its predictive value for the 2015 consensus-based definition of trauma activation has not been validated. We sought to assess this relationship.
Methods: We retrospectively reviewed all patients between the ages of 4 and 16 years who presented to our center between June 2012 and May 2018 with blunt trauma and injury severity score >15. We reviewed for age-adjusted hypotension, calculated the SIPA, determined if it was elevated based on their age group (4-6, 7-12, and 13-16), and evaluated whether patients met criteria for trauma activation based on the consensus definition.
Results: A total of 232 patients were included, with 94 (40.5%) meeting the definition for activation. Of the 179 (77.2%) with a normal SIPA, 67 (37.4%) met the definition for activation. Of the 53 (22.8%) with an elevated SIPA, 27 (50.9%) met the definition for activation. This difference was not statistically significant (p=0.08). Sensitivity was 29% and specificity was 81%. Of the 24 (10.3%) with age-adjusted hypotension, 15 (62.5%) met the definition for activation. Of the 208 (89.7%) without age-adjusted hypotension, 79 (38.0%) met the definition for activation. This difference was statistically significant (p=0.02). Sensitivity was 16% and specificity was 93%.
Conclusion: Although neither is especially accurate in predicting the need for trauma activation, age-adjusted hypotension appears to be more predictive than elevated SIPA in patients with ISS >15.
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