Yang Ya-Chih, Hsieh Tsung-Han, Liu Chi-Yuan, Chang Chun-Yu, Hou Yueh-Tseng, Lin Po-Chen, Chen Yu-Long, Chien Da-Sen, Yiang Giou-Teng, Wu Meng-Yu
Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, Taiwan.
Department of Emergency Medicine, School of Medicine, Tzu Chi University, Hualien 970, Taiwan.
Children (Basel). 2021 Aug 10;8(8):688. doi: 10.3390/children8080688.
The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock progression. In the elevated SIPA group, more severe traumatic injuries were identified, including high injury severity score (ISS), revised trauma score (RTS), and new injury severity score (NISS) scores than SI > 0.9. The odds ratio of elevated SIPA and SI (>0.9) to predict ISS ≥ 16 was 3.593 (95% Confidence interval [CI]: 2.175-5.935, < 0.001) and 2.329 (95% CI: 1.454-3.730, < 0.001). SI and SIPA are useful for identifying the compensatory phase of shock in prehospital and hospital settings, especially in corresponding normal to low-normal blood pressure. SIPA is effective in predicting the mortality and severity of traumatic injuries in the pediatric population. However, SI and SIPA were not significant predictors of ICU admission and the need for surgery analysis.
休克指数（SI）是预测创伤患者损伤严重程度和死亡率的有用工具。然而，儿科生理学与成人不同。在儿科创伤人群中，休克状态可能在生命体征的正常范围内被掩盖。与SI相比，儿科年龄调整后的SI（SIPA）报告更为准确。在我们的研究中，我们对儿科创伤人群进行了一项为期10年的回顾性队列研究，以评估SI和SIPA在预测死亡率、重症监护病房（ICU）入院率以及手术需求方面的作用。这项回顾性队列研究纳入了2009年1月至2019年6月在台北慈济医院有住院史的1265名儿科创伤患者。本研究的主要结局是住院死亡率，次要结局是住院时间和ICU住院时间、手术次数以及ICU入院次数。SIPA组能够早期检测生命体征变化以反映休克进展。在SIPA升高组中，发现的创伤性损伤更严重，包括损伤严重度评分（ISS）、修正创伤评分（RTS）和新损伤严重度评分（NISS）得分均高于SI>0.9的情况。SIPA升高和SI（>0.9）预测ISS≥16的优势比分别为3.593（95%置信区间[CI]：2.175 - 5.935，P<0.001）和2.329（95%CI：1.454 - 3.730，P<0.001）。SI和SIPA有助于在院前和医院环境中识别休克的代偿期，尤其是在血压正常至略低于正常的情况下。SIPA在预测儿科人群创伤性损伤的死亡率和严重程度方面有效。然而，SI和SIPA并非ICU入院率和手术需求分析的显著预测指标。
