title: Pediatric specific shock index accurately identifies severely injured children.
abstract: BACKGROUND
  Shock index (SI) (heart rate/systolic blood pressure)>0.9 predicts mortality in adult trauma patients. We hypothesized that age adjusted SI could more accurately predict outcomes in children.
  
  
  METHODS
  Retrospective review of children age 4-16 years admitted to two trauma centers between 1/07 and 6/13 following blunt trauma with an injury severity score (ISS)>15 was performed. We evaluated the ability of SI>0.9 at emergency department presentation and elevated shock index, pediatric age adjusted (SIPA) to predict outcomes. SIPA was defined by maximum normal HR and minimum normal SBP by age. Cutoffs included SI>1.22 (age 4-6), >1.0 (7-12), and >0.9 (13-16).
  
  
  RESULTS
  Among 543 children, 50% of children had an SI>0.9 but this fell to 28% using age adjusted SI (SIPA). SIPA demonstrated improved discrimination of severe injury relative to SI: ISS>30: 37% vs 26%; blood transfusion within the first 24 hours: 27% vs 20%; Grade III liver/spleen laceration requiring blood transfusion: 41% vs 26%; and in-hospital mortality: 11% vs 7%.
  
  
  CONCLUSIONS
  A pediatric specific shock index (SIPA) more accurately identifies children who are most severely injured, have intraabdominal injury requiring transfusion, and are at highest risk of death when compared to shock index unadjusted for age.
authors: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: Shannon.acker@ucdenver.edu.
authors: Shannon N
authors: SN
authors: Acker
authors: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: James.ross@ucdenver.edu.
authors: James T
authors: JT
authors: Ross
authors: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA. Electronic address: david.partrick@childrenscolorado.org.
authors: David A
authors: DA
authors: Partrick
authors: Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO USA. Electronic address: suhong.tong@ucdenver.edu.
authors: Suhong
authors: S
authors: Tong
authors: Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO USA; Department of Surgery, Denver Health Medical Center, Denver, CO USA. Electronic address: denis.bensard@dhha.org.
authors: Denis D
authors: DD
authors: Bensard
mesh_terms: D000293:Adolescent; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006339:Heart Rate; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D014193:Trauma Centers; D014218:Triage / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology
keywords: Pediatric trauma; Shock index; Triage tool; Vital signs