Nordin Andrew, Shi Junxin, Wheeler Krista, Xiang Henry, Kenney Brian
Nationwide Children's Hospital, Department of Pediatric Surgery, Columbus, OH; State University of New York University at Buffalo, Department of General Surgery, Buffalo, NY.
Center for Pediatric Trauma Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
J Pediatr Surg. 2019 May;54(5):984-988. doi: 10.1016/j.jpedsurg.2019.01.049. Epub 2019 Feb 27.
Studies have demonstrated the superiority of the shock index, pediatric age-adjusted (SIPA) in predicting outcomes in pediatric blunt trauma patients. However, all have utilized SIPA calculated on emergency department (ED) arrival. We sought to evaluate the utility of SIPA at the trauma scene and describe changes in SIPA from the trauma scene to the ED.
We used 2014-2016 Trauma Quality Improvement Program Data to identify blunt trauma patients 1-15 years old with an injury severity score (ISS) > 15. We calculated SIPA using vitals obtained at the trauma scene and on ED arrival. Outcome measures included ISS, transfusion within 24 h, intensive care unit (ICU), hospital length of stay (LOS), ventilator days, and mortality.
We identified 2917 patients, and 34.2% had a persistently elevated SI from the injury scene to ED arrival, whereas 17.9% had a persistently elevated SIPA. An elevated SIPA at the trauma scene was more predictive of greater ISS, LOS, and ventilator requirements. Furthermore, a SIPA that remained abnormal was associated with greater ISS, LOS, ICU admission, mechanical ventilation, and mortality.
Prehospital SIPA values predict worse outcomes in pediatric trauma patients, and their change over time may have greater predictive utility than a single value alone.
II TYPE OF STUDY: Prognosis Study.
研究已证明小儿年龄校正休克指数（SIPA）在预测小儿钝性创伤患者预后方面具有优越性。然而，所有研究均采用急诊科（ED）就诊时计算的SIPA。我们旨在评估创伤现场SIPA的效用，并描述从创伤现场到ED的SIPA变化。
我们使用2014 - 2016年创伤质量改进计划数据，确定年龄在1 - 15岁、损伤严重程度评分（ISS）> 15的钝性创伤患者。我们使用在创伤现场和ED就诊时获得的生命体征计算SIPA。结局指标包括ISS、24小时内输血情况、重症监护病房（ICU）、住院时间（LOS）、呼吸机使用天数和死亡率。
我们确定了2917例患者，34.2%的患者从受伤现场到ED就诊时休克指数（SI）持续升高，而17.9%的患者SIPA持续升高。创伤现场SIPA升高更能预测更高的ISS、LOS和呼吸机需求。此外，持续异常的SIPA与更高的ISS、LOS、ICU入院、机械通气和死亡率相关。
院前SIPA值可预测小儿创伤患者更差的预后，其随时间的变化可能比单一值具有更大的预测效用。
II 研究类型：预后研究。
