Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Department of Surgery, Pietermaritzburg Metropolitan Complex, University of KwaZulu-Natal, Pietermaritzburg, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
J Pediatr Surg. 2019 Dec;54(12):2621-2626. doi: 10.1016/j.jpedsurg.2019.08.021. Epub 2019 Aug 30.
Identification of injury severity and appropriate triage are critical to effective surgical care, especially where medical and surgical resources are strained. We hypothesized that pediatric age-adjusted shock index (SIPA) would outperform traditional shock index (SI) in a middle-income country (MIC) setting.
Injured children hospitalized in two trauma centers (South Africa and the United States) from 2012 to 2017 were reviewed. Maximum heart rate and minimum systolic blood pressure defined SI. SI > 0.9 defined elevation. SIPA elevation was based on SI stratified by age: 1-6 years (SI > 1.22), 7-12 years (SI > 1.0), and 13-17 years (SI > 0.9). SI and SIPA were compared using univariate analyses and area under the receiver operating characteristic curves (AUROC).
1648 patients (741 MIC and 907 high-income country (HIC)) were evaluated with a median [IQR] age of 11 [6-15] years. SI was elevated in 377 (51%) MIC children, whereas SIPA was elevated in 248 (34%). In both the HIC and MIC, elevated SIPA was more associated with ISS ≥ 25, ICU admission, and mortality. In MIC patients specifically, elevated SIPA improved discrimination for in-hospital mortality (AUROC 0.66 vs AUROC 0.57, p < 0.01).
In a multinational cohort including MIC patients, SIPA facilitated identification of injured children with altered physiology, reflecting greater injury severity and poorer outcomes. Use of SIPA has the potential for more effective resource utilization in MICs.
Level III.
在医疗和外科资源紧张的情况下，准确识别创伤严重程度和进行适当的分诊对于有效的外科治疗至关重要。我们假设，在中低收入国家（MIC）环境中，儿科年龄调整休克指数（SIPA）将优于传统休克指数（SI）。
回顾了 2012 年至 2017 年期间在两家创伤中心（南非和美国）住院的受伤儿童。最大心率和最低收缩压定义 SI。SI>0.9 定义为升高。SIPA 升高基于按年龄分层的 SI：1-6 岁（SI>1.22）、7-12 岁（SI>1.0）和 13-17 岁（SI>0.9）。使用单变量分析和受试者工作特征曲线下面积（AUROC）比较 SI 和 SIPA。
共评估了 1648 例患者（741 例 MIC 和 907 例高收入国家（HIC）），中位数[IQR]年龄为 11[6-15]岁。377 例（51%）MIC 儿童的 SI 升高，而 248 例（34%）的 SIPA 升高。在 HIC 和 MIC 中，SIPA 升高与 ISS≥25、入住 ICU 和死亡率的相关性更强。特别是在 MIC 患者中，SIPA 升高提高了院内死亡率的预测能力（AUROC 0.66 与 AUROC 0.57，p<0.01）。
在包括 MIC 患者的多国队列中，SIPA 有助于识别生理状态改变的受伤儿童，反映出更严重的损伤程度和更差的预后。SIPA 的使用有可能在 MIC 中更有效地利用资源。
III 级。
