From the Department of Surgery (C.W.M., W.S.D., D.T.L., J.D.H., M.J.E.), Madigan Army Medical Center, Tacoma, Washington; and Department of Surgery (K.A.), Oregon Health and Science University, Doernbecher Children's Hospital, Portland, Oregon.
J Trauma Acute Care Surg. 2020 Oct;89(4):642-648. doi: 10.1097/TA.0000000000002655.
Shock Index Pediatric-Adjusted (SIPA) has been used to predict injury severity and outcomes after civilian pediatric trauma. We hypothesize that SIPA can predict the need for blood transfusion and emergent surgery among pediatric patients injured in warzones, where resources are limited and accurate triage is essential.
Retrospective review of the DoD Trauma Registry for all patients 17 years or younger, from 2008 to 2015. Shock Index Pediatric-Adjusted was determined using vital signs recorded upon arrival to the initial level of care. Patients were classified into two groups (normal vs. elevated SIPA) using age-specific threshold values. The need for blood product transfusion (BPT) within 24 hours and emergent surgical procedures (ESP) was compared between groups. Intensive care unit admission, injury severity, and mortality were also compared. Regression analysis was performed to evaluate the relationship between SIPA and primary outcomes.
There were 2,121 patients included with a mean Injury Severity Score of 12 ± 10. The mechanism of injury was penetrating (63%), blunt (25%), and burns (12%). Patients with an elevated SIPA (43%) had a significantly greater need for BPT (49.2% vs. 25.0%) and ESP (22.9% vs. 16.0%), as well as mortality (10.3% vs. 4.8%) and intensive care unit admission (49.9% vs. 36.1%), all p less than 0.001. Regression analysis confirmed an elevated SIPA as independently associated with both BPT (odds ratio, 2.36; 95% confidence interval, 1.19-2.94; p < 0.001) and ESP (odds ratio, 1.29; 95% confidence interval, 1.01-1.64; p = 0.044).
This is the first study of SIPA in pediatric warzone trauma. Elevated SIPA is associated with significantly increased need for BPT and emergent surgery and may therefore serve as a valuable tool for planning and triage in austere settings.
Prognostic/epidemiological, Level III.
休克指数儿科调整（SIPA）已被用于预测平民儿科创伤后的严重程度和结果。我们假设 SIPA 可以预测战区儿科患者是否需要输血和紧急手术，因为战区资源有限，准确分诊至关重要。
回顾性分析 2008 年至 2015 年期间国防部创伤登记处所有 17 岁以下的患者。使用到达初始护理水平时记录的生命体征确定儿科调整后的休克指数。使用特定年龄的阈值将患者分为两组（正常 SIPA 与升高 SIPA）。比较两组患者在 24 小时内是否需要输血（BPT）和紧急手术（ESP）。还比较了重症监护病房入住率、损伤严重程度和死亡率。回归分析评估了 SIPA 与主要结局之间的关系。
共纳入 2121 例患者，平均损伤严重度评分为 12±10。损伤机制为穿透性（63%）、钝性（25%）和烧伤（12%）。SIPA 升高的患者（43%）更需要 BPT（49.2% vs. 25.0%）和 ESP（22.9% vs. 16.0%），死亡率（10.3% vs. 4.8%）和 ICU 入住率（49.9% vs. 36.1%）更高，所有 p 值均小于 0.001。回归分析证实，SIPA 升高与 BPT（优势比，2.36；95%置信区间，1.19-2.94；p<0.001）和 ESP（优势比，1.29；95%置信区间，1.01-1.64；p=0.044）独立相关。
这是第一份关于战区儿科创伤中 SIPA 的研究。SIPA 升高与 BPT 和紧急手术的需求显著增加相关，因此可能成为资源匮乏环境下计划和分诊的有价值工具。
预后/流行病学，III 级。
