Vandewalle Robert J, Peceny Julia K, Dolejs Scott C, Raymond Jodi L, Rouse Thomas M
Indiana University School of Medicine, Department of Surgery, Division of Pediatric Surgery.
Indiana University School of Medicine.
J Pediatr Surg. 2018 Feb;53(2):362-366. doi: 10.1016/j.jpedsurg.2017.10.045. Epub 2017 Oct 14.
The utility of measuring the pediatric adjusted shock index (SIPA) at admission for predicting severity of blunt injury in pediatric patients has been previously reported. However, the utility of following SIPA after admission is not well described.
The trauma registry from a level-one pediatric trauma center was queried from January 1, 2010 to December 31, 2015. Patients were included if they were between 4 and 16years old at the time of admission, sustained a blunt injury with an Injury Severity Score≥15, and were admitted less than 12h after their injury (n=286). Each patient's SIPA was then calculated at 0, 12, 24, 36, and 48h after admission and then categorized as elevated or normal at each time frame based upon previously reported values. Trends in outcome variables as a function of time from admission for patients with an abnormal SIPA to normalize as well as patients with a normal admission SIPA to abnormal were analyzed.
In patients with a normal SIPA at arrival, 18.4% of patients who developed an elevated SIPA at 12h after admission died, whereas 2.4% of patients who maintained a normal SIPA throughout the first 48h of admission died (p<0.01). Among patients with an elevated SIPA at arrival, increased length of time to normalize SIPA correlated with increased length of stay (LOS) and intensive care unit (ICU) LOS. Similarly, elevation of SIPA after arrival in patients with a normal initial SIPA correlated to increased LOS and ICU LOS.
Patients with a normal SIPA at time of arrival who then have an elevated SIPA in the first 24h of admission are at increased risk for morbidity and mortality compared to those whose SIPA remains normal throughout the first 48h of admission. Similarly, time to normalize an elevated admission SIPA appears to directly correlate with LOS, ICU LOS, and other markers of morbidity across a mixed blunt trauma population. Whether trending SIPA early in the hospital course serves only as a marker for injury severity or if it has utility as a resuscitation metric has not yet been determined.
Prognostic.
Level II.
先前已有报道称，入院时测量儿童校正休克指数（SIPA）对预测儿科患者钝性损伤的严重程度具有实用性。然而，入院后跟踪SIPA的实用性尚未得到充分描述。
查询了一家一级儿科创伤中心2010年1月1日至2015年12月31日的创伤登记资料。纳入标准为入院时年龄在4至16岁之间、钝性损伤且损伤严重程度评分≥15分、受伤后12小时内入院的患者（n = 286）。然后在入院后0、12、24、36和48小时计算每位患者的SIPA，并根据先前报道的值在每个时间点将其分类为升高或正常。分析了入院后SIPA异常的患者SIPA恢复正常以及入院时SIPA正常的患者SIPA变为异常时，结局变量随时间的变化趋势。
入院时SIPA正常的患者中，入院后12小时SIPA升高的患者中有18.4%死亡，而入院后头48小时SIPA一直保持正常的患者中有2.4%死亡（p<0.01）。入院时SIPA升高的患者中，SIPA恢复正常的时间越长，住院时间（LOS）和重症监护病房（ICU）住院时间越长。同样，初始SIPA正常的患者入院后SIPA升高与LOS和ICU LOS增加相关。
与入院后头48小时SIPA一直保持正常的患者相比，入院时SIPA正常但入院后24小时内SIPA升高的患者发病和死亡风险增加。同样，入院时升高的SIPA恢复正常的时间似乎与混合钝性创伤人群的LOS、ICU LOS及其他发病指标直接相关。在病程早期跟踪SIPA是仅作为损伤严重程度的指标，还是具有作为复苏指标的效用，尚未确定。
预后研究。
二级。
