PTS Home  |  Past & Future Meetings
Pediatric Trauma Society

Back to 2022 Abstracts


Use of Pre-hospital Reverse Shock Index Times Glasgow Coma Scale to Identify Children Who Require the Most Immediate Trauma Care
Marina Reppucci, Margo Nolan, Emily Cooper, Jenny Stevens, Swati Jujare, Lauren Gallagher, Bailey Lyttle, Steven Moulton, Denis Bensard, Shannon Acker
Children's Hospital Colorado, Aurora, CO

Background: Appropriate pre-hospital trauma triage ensures transport of children to facilities that provide specialized trauma care resulting in improved outcomes. We currently lack an objective, generalizable scoring tool for emergency medical services (EMS) to facilitate accurate trauma triage. The reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to accurately identify severely injured children. This study sought to determine if rSIG could identify injured children in the pre-hospital setting who require the highest levels of care.
Methods: Patients (1-18 years old) transferred from the scene to our level 1 pediatric trauma center from 2010 - 2020 with complete pre-hospital and emergency department (ED) vital signs and Glasgow Coma Scale (GCS) score were included. rSIG was calculated as previously described [(SBP/HR) x GCS], and the following cutoffs were used: ≤13.1, ≤16.5, and ≤20.1 for 1-6, 7-12, and 13-18 year olds, respectively. Trauma activation level and clinical outcomes upon arrival to our PTC were collected.
Results: There were 247 patients included in the analysis; 66.0% (163) had an abnormal rSIG in the field. Patients with an abnormal rSIG had a higher rate of highest-level trauma activation compared to those with normal rSIG (38.7% vs 20.2%, p=0.013). Patients with an abnormal pre-hospital rSIG also had higher rates of intubation, intracranial pressure (ICP) monitor, need for blood transfusion, and laparotomy (Table 1).
Conclusions: Patients identified as having an abnormal rSIG in the field were more likely to require the highest-level trauma activation upon arrival to the ED. It can be utilized by EMS to identify children most in need of higher levels of care and ensure triage to appropriate facilities.

Table 1. Trauma Related Interventions Based on rSIG
Abnormal Pre-Hospital rSIG (n=163)Normal Pre-Hospital rSIG (n=84)p-value
Intubation47 (28.8%)8 (9.5%)<0.001
ICP Monitor15 (9.2%)1 (1.2%)0.032
Blood Transfusion32 (19.6%)7 (8.3%)0.034
Laparotomy13 (8.0%)1 (1.2%)0.039

Back to 2022 Abstracts