Predicting morbidity and mortality in Australian paediatric trauma with the Paediatric Age-Adjusted Shock Index and Glasgow Coma Scale |
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| Affiliation: | 1. Trauma unit, Department of Surgery, Children''s Hospital at Westmead, Australia;2. Department of Surgery, School of Medicine, Faculty of Medicine and Health, University of Sydney, Australia;1. Department of Orthopaedic Surgery, Duke University, NC, USA;2. Department of Orthopaedic Surgery, Stanford University, CA, USA;3. School of Pharmacy, Chongqing Medical University, Chongqing, China;4. Department of Mechanical Engineering, Stanford University, CA, USA;5. Department of Bioengineering, Stanford University, CA, USA;6. Department of Chemistry, Stanford University, CA, USA;1. Department of Orthopaedic Surgery, The Johns Hopkins University, 601N Caroline St 5th floor, Baltimore, MD 21205, United States;2. Department of Neurology, The Johns Hopkins University, Baltimore, MD, United States;3. Department of Orthopaedic Surgery, University of California, Irvine, Irvine, CA, United States;1. Karolinska Institutet, Department of Clinical Science Intervention and Technology, Sweden;2. Swedish Armed Forces, Defence Inspectorate for Medicine and Environmental Health, Tegeluddsvägen 100 SE-107 85, Stockholm, Sweden;3. Orthopedic Clinic, Vällingby-Läkarhuset, Praktikertjänst AB, Sweden;4. Karolinska Institutet, Department of Molecular Medicine and Surgery;5. Theme Acute and Repair Medicine, Karolinska University Hospital, Stockholm, Sweden;6. Department of Geriatrics, Stockholm Nursing Home, Sweden;7. Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital, Stockholm, Sweden;8. Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden;9. Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm Sweden;10. Reconstructive Orthopedics, Karolinska University Hospital, Huddinge, Stockholm, Sweden;1. Senior Resident, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany;2. Dresden Center for Intelligent Materials (DCIM), Technische Universität Dresden, Dresden, Germany;3. Assistant Professor, Department of Civil and Environmental Engineering, University of Massachusetts, Amherst, MA, USA;4. Senior Consultant, Department of Oral & Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Germany |
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| Abstract: | BackgroundPaediatric age-adjusted shock index (SIPA) has emerged as a predictor of morbidity and mortality in trauma. Poor sensitivity and low generalisability demonstrated in previous studies have limited its use. We evaluate the use of SIPA in the general Australian paediatric trauma population and the combination of SIPA with GCS.MethodsAll patients from January 2015 to August 2020 at a major Australian paediatric trauma centre were reviewed. Pre-arrival SIPA (pSIPA) and arrival SIPA (aSIPA) were calculated. If SIPA was elevated or the Glasgow Coma Scale ≤ 13, SIPA with mental state (SIPAms) was marked positive for pre-arrival (pSIPAms) and arrival (aSIPAms) respectively.Results/DiscussionData from 480 patients were analysed. pSIPA and aSIPA poorly predicted outcomes of morbidity. Only aSIPA predicted mortality. However, both pre-arrival and arrival SIPAms variables predict mortality, major trauma (ISS≥12), hospital LOS, need for ICU admission, and major surgery. Furthermore, median ISS and lactate were significantly higher in positive pSIPA, aSIPA, pSIPAms, and aSIPAms groups than negative. aSIPAms has a sensitivity of 76% and specificity of 70% for major trauma.ConclusionBroad inclusion criteria reduce SIPA's ability to predict morbidity. Combining it with GCS improves this and is most valuable when calculated at arrival. In addition, the score is more reliable for major trauma (ISS≥12). Future studies should evaluate the use of SIPAms in activation criteria. |
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