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Ramsey WA, Huerta CT, O'Neil CF, Stottlemyre RL, Saberi RA, Gilna GP, Lyons NB, Collie BL, Parker BM, Perez EA, Sola JE, Proctor KG, Namias N, Thorson CM, Meizoso JP. Admission to a Verified Pediatric Trauma Center is Associated With Improved Outcomes in Severely Injured Children. J Pediatr Surg 2024; 59:488-493. [PMID: 37993397 DOI: 10.1016/j.jpedsurg.2023.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Previous studies have shown improved survival for severely injured adult patients treated at American College of Surgeons verified level I/II trauma centers compared to level III and undesignated centers. However, this relationship has not been well established in pediatric trauma centers (PTCs). We hypothesize that severely injured children will have lower mortality at verified level I/II PTCs compared to centers without PTC verification. METHODS All patients 1-15 years of age with ISS >15 in the 2017-2019 American College of Surgeons Trauma Quality Programs (ACS TQP) dataset were reviewed. Patients with pre-hospital cardiac arrest, burns, and those transferred out for ongoing inpatient care were excluded. Logistic regression models were used to assess the effects of pediatric trauma center verification on mortality. RESULTS 16,301 patients were identified (64 % male, median ISS 21 [17-27]), and 60 % were admitted to verified PTCs. Overall mortality was 6.0 %. Mortality at centers with PTC verification was 5.1 % versus 7.3 % at centers without PTC verification (p < 0.001). After controlling for injury mechanism, sex, age, pediatric-adjusted shock index (SIPA), ISS, arrival via interhospital transfer, and adult trauma center verification, pediatric level I/II trauma center designation was independently associated with decreased mortality (OR 0.72, 95 % CI 0.61-0.85). CONCLUSIONS Treatment at ACS-verified pediatric trauma centers is associated with improved survival in critically injured children. These findings highlight the importance of PTC verification in optimizing outcomes for severely injured pediatric patients and should influence trauma center apportionment and prehospital triage. LEVEL OF EVIDENCE Level IV - Retrospective review of national database.
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Affiliation(s)
- Walter A Ramsey
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Carlos T Huerta
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Christopher F O'Neil
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | | | - Rebecca A Saberi
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Gareth P Gilna
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicole B Lyons
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Brianna L Collie
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Brandon M Parker
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Eduardo A Perez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Juan E Sola
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kenneth G Proctor
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Nicholas Namias
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan P Meizoso
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Ryder Trauma Center, Jackson Memorial Hospital, Miami, FL, USA.
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Kinjalk M, Jain N, Neogi S, Ratan SK, Panda SS, Sehgal M, Arora V. Pediatric Age-adjusted Shock Index (SIPA): From Injury to Outcome in Blunt Abdominal Trauma. J Indian Assoc Pediatr Surg 2024; 29:33-38. [PMID: 38405261 PMCID: PMC10883172 DOI: 10.4103/jiaps.jiaps_156_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/16/2023] [Accepted: 08/27/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose The Shock Index Pediatric Age-Adjusted (SIPA) score is a useful tool for identifying pediatric trauma patients at a risk of poor outcomes and for triaging. We are studying the relationship between elevated SIPA score and specific outcomes in pediatric trauma patients. Materials and Methods A retrospective study was conducted in which case records of 58 pediatric patients with blunt abdominal trauma were evaluated and tabulated for their SIPA scores only at the time of their initial presentation and categorized into two groups - normal SIPA and elevated SIPA. The primary outcomes were need for blood transfusion, need for any intervention, and need for emergency surgery, and the secondary outcomes were need for computed tomography (CT) scan, need for a ventilator, intensive care unit (ICU) stay, length of hospital stay, and mortality. Statistical methods were applied to find a relationship between elevated SIPA score and the primary and secondary outcomes. Results An elevated SIPA score was noted in 27 (46%) patients. There was a significant relationship between elevated SIPA scores and patients needing blood transfusion (68.75%, n = 11) and length of hospital stay (10.48 ± 7.54 days). A significant relationship between elevated SIPA score and need for emergency surgery (54.54%, n = 6), need for a CT scan (56%, n = 14), and ICU stay (50%, n = 2) was not found. Conclusion We have seen in our study that elevated SIPA scores at presentation are significantly related to need for blood transfusion and length of hospital stay. In more than half of the patients, elevated SIPA was associated with need for emergency surgery and requirement of CT scan, but it was statistically not significant. Therefore, assessment of this parameter can help in identifying such poor outcomes.
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Affiliation(s)
- Meghna Kinjalk
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Nitin Jain
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Sujoy Neogi
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Simmi K. Ratan
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | | | - Mehak Sehgal
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
| | - Vanshika Arora
- Department of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India
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Reppucci ML, Cooper E, Stevens J, Meier M, Nolan MM, Moulton SL, Bensard DD, Acker SN. Comparison of Pediatric Trauma Scoring Tools That Incorporate Neurological Status for Trauma Team Activation. Pediatr Emerg Care 2023; 39:501-506. [PMID: 37276058 DOI: 10.1097/pec.0000000000002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Two novel pediatric trauma scoring tools, SIPAB+ (defined as elevated SIPA with Glasgow Coma Scale ≤8) and rSIG (reverse Shock Index multiplied by Glasgow Coma Scale and defined as abnormal using cutoffs for early outcomes), which combine neurological status with Pediatric Age-Adjusted Shock Index (SIPA), have been shown to predict early trauma outcomes better than SIPA alone. We sought to determine if one more accurately identifies children in need of trauma team activation. METHODS Patients 1 to 18 years old from the 2014-2018 Pediatric Trauma Quality Improvement Program database were included. Sensitivity and specificity for SIPAB+ and rSIG were calculated for components of pediatric trauma team activation, based on criteria standard definitions. RESULTS There were 11,426 patients (1.9%) classified as SIPAB+ and 235,672 (39.0%) as having an abnormal rSIG. SIPAB+ was consistently more specific, with specificities exceeding 98%, but its sensitivity was poor (<30%) for all outcomes. In comparison, rSIG was a more sensitive tool, with sensitivities exceeding 60%, and specificity values exceeded 60% for all outcomes. CONCLUSIONS Trauma systems must determine their priorities to decide how best to incorporate SIPAB+ and rSIG into practice, although rSIG may be preferred as it balances both sensitivity and specificity. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Emily Cooper
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora
| | | | - Maxene Meier
- The Center for Research in Outcomes for Children's Surgery, Center for Children's Surgery, University of Colorado School of Medicine, Aurora
| | - Margo M Nolan
- From the Pediatric Surgery, Children's Hospital Colorado, Aurora
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Adding age-adjusted shock index to the American College of Surgeons' trauma team activation criteria to predict severe injury in children. J Trauma Acute Care Surg 2023; 94:295-303. [PMID: 36694336 DOI: 10.1097/ta.0000000000003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American College of Surgeons (ACS) requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation. Our goal was to evaluate the effect of adding age-adjusted shock index (SI) to the ACS-6 for the prediction of severe injury among pediatric trauma patients with the hypothesis that SI would significantly improve sensitivity with an acceptable decrease in specificity. METHODS We performed a secondary analysis of prospectively collected EMS and trauma registry data from two urban pediatric trauma centers. Age-adjusted SI thresholds were calculated as heart rate divided by systolic blood pressure using 2020 Pediatric Advanced Life Support SI vital sign ranges and previously published Shock Index, Pediatric Adjusted (SIPA) thresholds. The primary outcome was a composite of emergency operative (within 1 hour of arrival) or emergency procedural intervention (EOPI) or Injury Severity Score (ISS) greater than 15. Sensitivities, specificities, and 95% CIs were calculated for the ACS-6 alone and in combination with age-adjusted SI. RESULTS There were 8,078 patients included; 20% had an elevated age-adjusted SI and 17% met at least one ACS minimum criterion; 1% underwent EOPI; and 17% had ISS >15. Sensitivity and specificity of the ACS-6 for EOPI or ISS > 5 were 45% (95% confidence interval [CI], 41-50%) and 89% (95% CI, 81-96%). Inclusion of Pediatric Advanced Life Support-SI and SIPA resulted in sensitivities of 51% (95% CI, 47-56%) and 69% (95% CI, 65-72%), and specificities of 80% (95% CI, 71-89%) and 60% (95% CI, 53-68%), respectively. Similar trends were seen for each secondary outcome. CONCLUSION In this cohort of pediatric trauma registry patients, the addition of SIPA to the ACS-6 for trauma team activation resulted in significantly increased sensitivity for EOPI or ISS greater than 15 but poor specificity. Future investigation should explore using age-adjusted shock index in a two-tiered trauma activation system, or in combination with novel triage criteria, in a population-based cohort. LEVEL OF EVIDENCE Diagnostic Tests or Criteria; Level II.
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Georgette N, Keskey R, Mbadiwe N, Hampton D, McQueen A, Slidell MB. Alternative shock index cutoffs for pediatric patients outperform the Shock Index Pediatric Age-adjusted (SIPA) on strength of association with adverse outcomes in pediatric trauma patients. Surgery 2022; 172:343-348. [DOI: 10.1016/j.surg.2022.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/10/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
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