Delta Shock Index Predicts Outcomes in Pediatric Trauma Patients Regardless of Age

Introduction: Changes in the shock index (Delta SI) can be a predictive tool but is not established among pediatric trauma patients. The aim of our study was to assess the impact of Delta SI on mortality in pediatric trauma patients. Methods: We performed a 2017 analysis of all pediatric trauma patients (age 0-16 y) from the ACS-TQIP. SI was defined as heart rate(HR)/systolic blood pressure(SBP). We abstracted the SI in the field (EMS), SI in the emergency department (ED) and calculated the change in SI (Delta SI = ED SI-EMS SI). Patients were divided into four age groups: 0-3 y, 4-6 y, 7-12 y, and 1316 y and substratified into two groups based on the value of the age-group-specific Delta SI cutoff obtained with receiver operating characteristic ROC analysis; +Delta SI and -Delta SI. Our outcome measure was mortality. Multivariable logistic and Cox regression analyses were performed. Results: We included 31,490 patients. Mean age was 10.6 4.6 y, and 65.8% were male. The overall mortality rate was 1.4%. In the age group 0-3 y the cutoff point for Delta SI was 0.29 with an area under the curve (AUC) 0.70 [0.62-0.79], Delta SI cutoff 4-6 y was 0.41 AUC 0.81 [0.70-0.92], Delta SI cutoff 7-12 y was 0.05 AUC 0.83 [0.76-0.90], and Delta SI cutoff 13-16 y was 0.13 AUC 0.75 [0.69-0.81]. On the Cox regression analysis, +Delta SI was independently associated with increased in-hospital mortality and 24-h mortality (P <= 0.01). Conclusions: Vital signs vary by age group in children, but Delta SI inherently accounts for this variation. Delta SI predicts mortality and may be utilized as a predictor to help guide triage of pediatric trauma patients. (C) 2020 Elsevier Inc. All rights reserved.

Automated summary

The study on Delta SI in pediatric trauma patients found that Delta SI can predict mortality. There are variations in vital signs among different age groups of children, but Delta SI inherently accounts for this variation.