A pediatric specific shock index in combination with GMS identifies children with life threatening or severe traumatic brain injury.
OBJECTIVE
We have previously demonstrated that a shock index, pediatric age adjusted (SIPA) accurately identifies severely blunt injured children. We aimed to determine if SIPA could more accurately identify children with severe traumatic brain injury (TBI) than hypotension alone.


METHODS
We performed subset analysis of those children with TBI among a cohort of children age 4-16 years with blunt trauma and injury severity score ≥15 from 1/07 to 6/13. We evaluated the ability of four markers to identify the most severely brain injured children. Markers included hypotension, elevated SIPA, abnormal GCS motor score (GMS), and elevated SIPA or abnormal GMS. We aimed to determine which of these four markers had the highest sensitivity in identifying severely injured children.


RESULTS
Three hundred and ninety-two (392) children were included. Hypotension was present in 24 patients (6%); elevated SIPA in 106 (27 %), abnormal GMS in 172 (44%), and elevated SIPA or abnormal GMS in 206 (53%). All markers were able to accurately identify severely injured children with TBI. Elevated SIPA or abnormal GMS identified a greater percentage of patients with each of seven complications with higher sensitivity than each of the three other markers.


CONCLUSIONS
Among blunt injured children with TBI, elevated SIPA or abnormal GMS identifies severely brain injured children.
Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA. shannon.acker@ucdenver.edu.
Shannon N
http://orcid.org/0000-0002-6969-4253
SN
Acker
Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA. James.ross2@ucsf.edu.
James T
JT
Ross
Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA. david.partrick@childrenscolorado.org.
David A
DA
Partrick
Department of Surgery, Denver Health Medical Center, Denver, CO, USA. denis.bensard@dhha.org.
Denis D
DD
Bensard
D000293:Adolescent; D001794:Blood Pressure / Q000502:physiology*; D001930:Brain Injuries / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D015203:Reproducibility of Results
Age adjusted shock index; Children; Hypotension; Shock index; Traumatic brain injury