Choi Sol Ji, Kim Min Joung, Kim Ha Yan, Park Shin Young, Park Yoo Seok, Kim Moon Kyu, Lee Ji Hwan, Yoon Seo Hee
Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
Department of Emergency Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
J Clin Med. 2025 Apr 26;14(9):2994. doi: 10.3390/jcm14092994.
: Despite the growing burden caused by pediatric trauma, the accuracy of prehospital triage remains suboptimal due to the lack of reliable pediatric-specific tools. In this study, we aimed to evaluate the predictive validity of the reverse shock index multiplied by the Glasgow Coma Scale (rSIG) for in-hospital mortality in pediatric trauma patients and to determine appropriate age-specific rSIG cutoff values for triage use. : We conducted a multicenter retrospective observational study using data from the Korean Emergency Department-Based Injury In-Depth Surveillance registry; these data covered trauma patients aged ≤18 years, spanning the period from 2011 to 2022. The rSIG was calculated using the initial vital signs and Glasgow Coma Scale scores upon arrival at the emergency department. Age groups with shared rSIG cutoffs were identified using the area under the receiver operating characteristic curve (AUC) and Akaike information criterion. Cutoff values were derived using the Youden index or further optimized to align with triage goals (<5% under-triage, <35% over-triage). : Among 333,995 pediatric trauma patients, the in-hospital mortality rate was 0.07%. The rSIG cutoff values derived using the Youden index showed strong predictive performance, with an AUC of 0.920 (95% CI: 0.897-0.943). The cutoff values adjusted to meet triage goals-13.3 for those aged 0-9 years, 18.4 for 10-14 years, and 20.9 for 15-18 years-achieved the best balance, with 30.94% over-triage and 9.17% under-triage. : The rSIG is a reliable predictor of in-hospital mortality in pediatric trauma cases. We recommend using cutoff values that are optimized to meet triage goals. Further research is warranted to develop standardized methods to derive triage-appropriate cutoff values.
尽管小儿创伤造成的负担日益加重，但由于缺乏可靠的儿科专用工具，院前分诊的准确性仍不尽人意。在本研究中，我们旨在评估反向休克指数乘以格拉斯哥昏迷量表（rSIG）对小儿创伤患者院内死亡率的预测效度，并确定适用于分诊的特定年龄rSIG临界值。我们开展了一项多中心回顾性观察研究，使用来自韩国基于急诊科的损伤深度监测登记处的数据；这些数据涵盖了2011年至2022年期间年龄≤18岁的创伤患者。rSIG是根据到达急诊科时的初始生命体征和格拉斯哥昏迷量表评分计算得出的。使用受试者操作特征曲线（AUC）下的面积和赤池信息准则确定具有共享rSIG临界值的年龄组。临界值是使用约登指数得出的，或进一步优化以符合分诊目标（分诊不足<5%，分诊过度<35%）。在333,995例小儿创伤患者中，院内死亡率为0.07%。使用约登指数得出的rSIG临界值显示出很强的预测性能，AUC为0.920（95%CI：0.897 - 0.943）。为满足分诊目标而调整的临界值——0至9岁为13.3，10至14岁为18.4，15至18岁为20.9——实现了最佳平衡，分诊过度为30.94%，分诊不足为9.17%。rSIG是小儿创伤病例院内死亡率的可靠预测指标。我们建议使用为满足分诊目标而优化的临界值。有必要开展进一步研究以开发得出适用于分诊的临界值的标准化方法。
