Shock Index Pediatric-adjusted (SIPA) as a Predictor of Pediatric Massive Transfusion in Warzone Trauma
*Christopher W. Marenco1, Daniel T. Lammers1, Woo S. Do1, Kaitlin R. Morte1, John D. Horton1, *Mauricio A. Escobar2, Matthew J. Eckert1
1Madigan Army Medical Center, Tacoma, WA; 2Mary Bridge Children's Hospital, Tacoma, WA
Background:Shock Index Pediatric-Adjusted (SIPA) has proven useful for the prediction of Massive Transfusion (MT) in civilian pediatric trauma patients.1 The purpose of this study was to evaluate the utility of SIPA for the prediction of MT in pediatric warzone trauma.
Methods:We performed a retrospective review of the Department of Defense Trauma Registry from 2008 to 2015. We included all patients 17 years of age and younger that were evaluated at combat hospitals for traumatic injuries during that time period. Patients were categorized by SIPA on arrival as either normal or elevated based on age-stratified cutoffs previously validated in warzone pediatric trauma.2 The incidence of MT (≥40cc/kg blood products within 24hrs) was then compared between groups. Patient demographics, injury mechanism/severity, and various laboratory values were also compared. Multivariate regression analysis was also conducted to further elucidate the relationship between MT and SIPA.
Results:610 patients were included in the study. The mean ISS for the cohort overall was 11±9. The most common mechanism of injury was penetrating (61.5%), followed by blunt (24.4%), and burns (13.9%). 43.1% (263) of patients had an elevated SIPA. For the group as a whole, 87 patients (14.3%) received MT. Patients with an elevated SIPA demonstrated significantly increased incidence of MT (22.4% v. 8.1%, p<0.001). On regression analysis, elevated SIPA was independently associated with MT.
Conclusion:Elevated SIPA is associated with significantly increased need for Massive Transfusion in pediatric warzone trauma, and could prove useful in triage of these critically injured patients.
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