Dante Nicholas J, Salvatore Ryan J, Carayannopoulos Nicolas L, Burjonrappa Sathyaprasad C
Department of Paediatric Surgery, Rutgers Robert Wood Johnson Medical School, 125 Paterson Street, Suite 3300, New Brunswick, NJ, 08901, USA.
Rutgers Robert Wood Johnson Medical School, USA.
J Pediatr Surg. 2025 Mar;60(3):162018. doi: 10.1016/j.jpedsurg.2024.162018. Epub 2024 Oct 21.
Previous studies have identified the reverse shock index x Glasgow Coma Scale (rSIG) as a tool for predicting the need for trauma intervention in pediatric patients. This study sought to investigate the utility of prehospital rSIG as a triage tool to predict the need for trauma-center level of care in a large pediatric cohort.
Data from the American College of Surgeons National Trauma Data Bank (NTDB) (2018-2020) were used. Patients aged 1-18 with valid values for prehospital systolic blood pressure (EMS SBP), prehospital heart rate (EMS HR), and EMS total GCS, were included. Prehospital rSIG was calculated as (EMS SBP/EMS HR) x EMS total GCS. Abnormal values for rSIG were defined as: ≤13.1, ≤16.5, and ≤20.1 for patients aged 1-6, 7-12, and 13-18, respectively. Injury severity was determined by Injury Severity Score (ISS). ISS 1-8 represented minor injury, 9-15 moderate injury, and 16 severe injury. Rates of hemorrhage control surgery, embolization, transfusion at 4 hours, mechanical ventilation, ICU stay 3 days, and mortality was compared between patients with abnormal vs. normal prehospital rSIG.
120,941 patients were included in the analysis; 60269 (49.8 %) had an abnormal prehospital rSIG. Patients with abnormal prehospital rSIG had significantly higher rates of 1 trauma intervention (23.3 % vs 8.3 %, p < 0.0001) and mortality (2.7 % vs 0.1 %, p < 0.0001). When stratified by injury severity, rates of 1 trauma intervention were significantly higher for patients with abnormal prehospital rSIG in minor (2.8 % vs. 1.5 %, p < 0.0001), moderate (18.9 % vs 10.5 %, p < 0.0001), and severe injury (69.8 % vs 43.1 %).
Prehospital rSIG appears to be an independent predictor of both trauma intervention and mortality, regardless of injury severity, in the pediatric trauma population. Use of prehospital rSIG may prove useful in triage situations, particularly mass casualty incidents, to determine need for trauma-center care.
先前的研究已将反向休克指数x格拉斯哥昏迷量表（rSIG）确定为预测儿科患者创伤干预需求的一种工具。本研究旨在调查院前rSIG作为一种分诊工具在预测一大群儿科患者创伤中心护理需求方面的效用。
使用了美国外科医师学会国家创伤数据库（NTDB）（2018 - 2020年）的数据。纳入年龄在1 - 18岁且院前收缩压（EMS SBP）、院前心率（EMS HR）和EMS总格拉斯哥昏迷量表有有效数值的患者。院前rSIG计算为（EMS SBP/EMS HR）x EMS总格拉斯哥昏迷量表。rSIG的异常值定义为：1 - 6岁患者≤13.1，7 - 12岁患者≤16.5，13 - 18岁患者≤20.1。损伤严重程度由损伤严重度评分（ISS）确定。ISS 1 - 8表示轻伤，9 - 15表示中度伤，16表示重伤。比较院前rSIG异常与正常的患者之间的出血控制手术率、栓塞率、4小时输血率、机械通气率、3天ICU住院率和死亡率。
120941例患者纳入分析；60269例（49.8%）院前rSIG异常。院前rSIG异常的患者进行1次创伤干预的比率（23.3%对8.3%，p < 0.0001）和死亡率（2.7%对0.1%，p < 0.0001）显著更高。按损伤严重程度分层时，院前rSIG异常的患者在轻伤（2.8%对1.5%，p < 0.0001）、中度伤（18.9%对10.5%，p < 0.0001）和重伤（69.8%对43.1%）情况下进行1次创伤干预的比率显著更高。
在儿科创伤人群中，无论损伤严重程度如何，院前rSIG似乎是创伤干预和死亡率的独立预测指标。在分诊情况下，尤其是大规模伤亡事件中，使用院前rSIG可能有助于确定对创伤中心护理的需求。
