Pediatric Shock Index Outperforms SIPA In Predicting Mortality, PICU Admission, And Need For Transfusion
Nathan Georgette1, Robert Keskey2, David Hampton2, Emily Alberto3, Nikunj Chokshi1, Tanya Zakrison2, Kenneth Wilson2, Alisa McQueen1, *Randall Burd3, *Mark Slidell1
1Comer Children's Hospital at the University of Chicago, Chicago, IL;2University of Chicago Medical Center, Chicago, IL;3Children's National Hospital, Washington, D.C., DC
Background: Shock index, pediatric adjusted (SIPA) has been widely applied in pediatric trauma but has significant limitations and is difficult to apply in the trauma bay. We hypothesized that a Pediatric Shock Index (PSI) equation based on better age-based vital signs would outperform SIPA.
Methods: Retrospective cohort of trauma patients age 1 to 18 years from TQP-PUF 2010-2018. Using published ATLS, age-based values for shock - and linear regression on the optimal SI cutoffs by age - we derived equations representing the PSI cutoff for children <=12 years and 13+ years old (Figure). We compared our age-based PSI to SIPA in predicting mortality, PICU admission, or early transfusion. A simplified “rapid PSI” (rPSI) equation was also compared to SIPA.
Results: 756,677 patients met inclusion criteria with 1.1% mortality, 19.3% PICU admission, and 2.0% requiring transfusion within 4 hours. Both PSI and rPSI achieved higher positive predictive values (PPV) vs SIPA (Figure). The negative predictive values (NPV) for both PSI and rPSI were similar to SIPA, with NPV for PSI versus SIPA being 99.3% versus 99.3% for mortality, and 98.9% versus 99.0% for early transfusion.
Conclusions: Both age-based PSI and rPSI outperform SIPA in predicting mortality, PICU admission, and need for early blood transfusion. The PSI may prove valuable for risk-stratification, and rPSI may be useful at the bedside.
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