Huang Kuo-Chen, Yang Ying, Li Chao-Jui, Cheng Fu-Jen, Huang Ying-Hsien, Chuang Po-Chun, Chiu I-Min
Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Front Pediatr. 2021 Sep 28;9:727466. doi: 10.3389/fped.2021.727466. eCollection 2021.
The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an early index of prognosis for non-traumatic children visiting the pediatric emergency department (ED) and were directly admitted to the intensive care unit (ICU). We hypothesized that an increase in SIPA values in the first 24 h of ICU admission would correlate with mortality and adverse outcomes. This multicenter retrospective study enrolled non-traumatic patients aged 1-17 years who presented to the pediatric ED and were directly admitted to the ICU from January 1, 2016, to December 31, 2018, in Taiwan. The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1-6), >1.0 (patient age: 7-12), and >0.9 (patient age: 12-17). The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes. In total, 1,732 patients were included. Of these, 1,050 (60.6%) were under 6 years old, and the median Pediatric Risk of Mortality score was 7 (5-10). In total, 4.7% of the patients died, 12.9% received mechanical ventilator (MV) support, and 11.1% received inotropic support. The SIPA value at 24 h after admission was associated with increased mortality [odds ratio (OR): 4.366, 95% confidence interval (CI): 2.392-7.969, < 0.001], MV support (OR: 1.826, 95% CI: 1.322-2.521, < 0.001), inotropic support (OR: 2.306, 95% CI: 1.599-3.326, < 0.001), and a long hospital length of stay (HLOS) (2.903 days, 95% CI: 1.734-4.271, < 0.001). Persistent abnormal SIPA value was associated with increased mortality (OR: 2.799, 95% CI: 1.566-5.001, = 0.001), MV support (OR: 1.457, 95% CI: 1.015-2.092, = 0.041), inotropic support (OR: 1.875, 95% CI: 1.287-2.833, = 0.001), and a long HLOS (3.2 days, 95% CI: 1.9-4.6, < 0.001). Patients with abnormal to normal SIPA values were associated with decreased mortality (OR: 0.258, 95% CI: 0.106-0.627, = 0.003), while patients with normal to abnormal SIPA values were associated with increased mortality (OR: 3.055, 95% CI: 1.472-5.930, = 0.002). In non-traumatic children admitted to the ICU from the ED, increased SIPA values at 24 h after ICU admission predicted high mortality and bad outcomes. Monitoring the trends in the SIPA could help with prognostication and optimize early management.
小儿年龄校正休克指数（SIPA）定义为最大正常心率除以按年龄计算的最小正常收缩压，可帮助预测小儿创伤后的发病和死亡风险。本研究调查了SIPA是否可作为就诊于儿科急诊科（ED）并直接入住重症监护病房（ICU）的非创伤性儿童的早期预后指标。我们假设ICU入院后24小时内SIPA值升高与死亡率和不良结局相关。这项多中心回顾性研究纳入了2016年1月1日至2018年12月31日期间在台湾就诊于儿科ED并直接入住ICU的1 - 17岁非创伤性患者。在到达ED时和ICU入院后24小时计算SIPA值。临界值包括SIPA值>1.2（患者年龄：1 - 6岁）、>1.0（患者年龄：7 - 12岁）和>0.9（患者年龄：12 - 17岁）。分析SIPA的效用以及ICU入院后24小时内SIPA的变化趋势以预测结局。总共纳入了1732例患者。其中，1050例（60.6%）年龄在6岁以下，儿童死亡风险评分中位数为7（5 - 10）。总共有4.7%的患者死亡，12.9%接受机械通气（MV）支持，11.1%接受血管活性药物支持。入院后24小时的SIPA值与死亡率增加相关[比值比（OR）：4.366，95%置信区间（CI）：2.392 - 7.969，P<0.001]、MV支持（OR：1.826，95%CI：1.322 - 2.521，P<0.001）、血管活性药物支持（OR：2.306，95%CI：1.599 - 3.326，P<0.001）以及住院时间延长（HLOS）（2.903天，95%CI：1.734 - 4.271，P<0.001）。持续异常的SIPA值与死亡率增加相关（OR：2.799，95%CI：1.566 - 5.001，P = 0.001）、MV支持（OR：1.457，95%CI：1.015 - 2.092，P = 0.041）、血管活性药物支持（OR：1.875，95%CI：1.287 - 2.833，P = 0.001）以及HLOS延长（3.2天，95%CI：1.9 - 4.6，P<0.001）。SIPA值从异常变为正常的患者死亡率降低（OR：0.258，95%CI：0.106 - 0.627，P = 0.003），而SIPA值从正常变为异常的患者死亡率增加（OR：3.055，95%CI：1.472 - 5.930，P = 0.002）。在从ED入住ICU的非创伤性儿童中，ICU入院后24小时SIPA值升高预示着高死亡率和不良结局。监测SIPA的变化趋势有助于预后评估并优化早期管理。
