Division of Trauma, Critical Care, Department of Surgery, Emergency Surgery, and Burns, College of Medicine, University of Arizona, Tucson, Arizona.
Department of Surgery, Westchester Medical Center, Valhalla, New York.
J Surg Res. 2021 Mar;259:182-191. doi: 10.1016/j.jss.2020.10.026. Epub 2020 Dec 5.
Changes in the shock index (ΔSI) can be a predictive tool but is not established among pediatric trauma patients. The aim of our study was to assess the impact of ΔSI on mortality in pediatric trauma patients.
We performed a 2017 analysis of all pediatric trauma patients (age 0-16 y) from the ACS-TQIP. SI was defined as heart rate(HR)/systolic blood pressure(SBP). We abstracted the SI in the field (EMS), SI in the emergency department (ED) and calculated the change in SI (ΔSI = ED SI-EMS SI). Patients were divided into four age groups: 0-3 y, 4-6 y, 7-12 y, and 13-16 y and substratified into two groups based on the value of the age-group-specific ΔSI cutoff obtained with receiver operating characteristic ROC analysis; +ΔSI and -ΔSI. Our outcome measure was mortality. Multivariable logistic and Cox regression analyses were performed.
We included 31,490 patients. Mean age was 10.6 ± 4.6 y, and 65.8% were male. The overall mortality rate was 1.4%. In the age group 0-3 y the cutoff point for ΔSI was 0.29 with an area under the curve (AUC) 0.70 [0.62-0.79], ΔSI cutoff 4-6 y was 0.41 AUC 0.81 [0.70-0.92], ΔSI cutoff 7-12 y was 0.05 AUC 0.83 [0.76-0.90], and ΔSI cutoff 13-16 y was 0.13 AUC 0.75 [0.69-0.81]. On the Cox regression analysis, +ΔSI was independently associated with increased in-hospital mortality and 24-h mortality (P ≤ 0.01).
Vital signs vary by age group in children, but ΔSI inherently accounts for this variation. ΔSI predicts mortality and may be utilized as a predictor to help guide triage of pediatric trauma patients.
Level III Prognostic.
休克指数（ΔSI）的变化可以作为一种预测工具，但在儿科创伤患者中尚未得到证实。我们的研究目的是评估 ΔSI 对儿科创伤患者死亡率的影响。
我们对 ACS-TQIP 中的所有儿科创伤患者（年龄 0-16 岁）进行了 2017 年分析。SI 定义为心率（HR）/收缩压（SBP）。我们在现场（EMS）提取 SI，在急诊科（ED）提取 SI，并计算 SI 的变化（ΔSI=ED SI-EMS SI）。患者分为四个年龄组：0-3 岁、4-6 岁、7-12 岁和 13-16 岁，并根据 ROC 分析获得的年龄组特异性 ΔSI 临界值将患者分为两组；+ΔSI 和 -ΔSI。我们的结局指标是死亡率。进行了多变量逻辑和 Cox 回归分析。
我们纳入了 31490 名患者。平均年龄为 10.6±4.6 岁，65.8%为男性。总体死亡率为 1.4%。在 0-3 岁年龄组，ΔSI 的临界值为 0.29，曲线下面积（AUC）为 0.70[0.62-0.79]，4-6 岁年龄组的ΔSI 临界值为 0.41，AUC 为 0.81[0.70-0.92]，7-12 岁年龄组的ΔSI 临界值为 0.05，AUC 为 0.83[0.76-0.90]，13-16 岁年龄组的ΔSI 临界值为 0.13，AUC 为 0.75[0.69-0.81]。在 Cox 回归分析中，+ΔSI 与住院期间和 24 小时死亡率的增加独立相关（P≤0.01）。
儿童的生命体征因年龄组而异，但 ΔSI 固有地考虑到了这种变化。ΔSI 预测死亡率，可作为指导儿科创伤患者分诊的预测指标。
III 级预后。
