title: Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study.
abstract: BACKGROUND
  Age-adjusted pediatric shock index (SIPA) does not require knowledge of age-adjusted blood pressure norms, yet correlates with mortality, serious injury, and need for transfusion in trauma. No prospective studies support its validity.
  
  
  METHODS
  A multicenter prospective observational study of patients 4-16years presenting April 2013-January 2016 with blunt liver and/or spleen injury (BLSI). SIPA (maximum heart rate/minimum systolic blood pressure) thresholds of >1.22, >1.0, and >0.9 in the emergency department were used for 4-6, 7-12 and 13-16year-olds, respectively. Patients with ISS ≤15 were excluded to conform to the original paper. Discrimination outcomes were compared between SIPA and shock index (SI).
  
  
  RESULTS
  Of 1008 patients, 386 met inclusion. SI was elevated in 321, and SIPA elevated in 282. The percentage of patients with elevated index (SI or SIPA) and blood transfusion within 24 hours (30% vs 34%), BLSI grade ≥3 requiring transfusion (28% vs 32%), operative intervention (14% vs 16%) and ICU admission (64% vs 67%) was higher in the SIPA group.
  
  
  CONCLUSIONS
  SIPA was validated in this multi-institutional prospective study and identified a higher percentage of children requiring additional resources than SI in BLSI patients. SIPA may be useful for determining necessary resources for injured patients with BLSI.
  
  
  METHODS
  Level II prognosis.
authors.affiliation: Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA.
authors.forename: Maria E
authors.initials: ME
authors.lastname: Linnaus
authors.affiliation: Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA. Electronic address: dnotrica@phoenixchildrens.com.
authors.forename: David M
authors.initials: DM
authors.lastname: Notrica
authors.affiliation: Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA.
authors.forename: Crystal S
authors.initials: CS
authors.lastname: Langlais
authors.affiliation: Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
authors.affiliation: American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Leys
authors.affiliation: Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016, USA; American Family Children's Hospital, 1675 Highland Ave, Madison, WI 53792, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ostlie
authors.affiliation: Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA.
authors.forename: R Todd
authors.initials: RT
authors.lastname: Maxson
authors.affiliation: Akron Children's Hospital, 1 Perkins Sq, Akron, OH 44308, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Ponsky
authors.affiliation: Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Tuggle
authors.affiliation: LeBonheur Children's Hospital, 50 N Dunlap St, Memphis, TN 38103, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Eubanks
authors.affiliation: Children's Healthcare of Atlanta, 1975 Century Blvd NE#6, Atlanta, GA 30345, USA.
authors.forename: Amina
authors.initials: A
authors.lastname: Bhatia
authors.affiliation: Children's Medical Center Dallas, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX 75235, USA.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Alder
authors.affiliation: Children's Medical Center Dallas, part of Children's Health(SM), 1935 Medical District Dr, Dallas, TX 75235, USA.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Greenwell
authors.affiliation: Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA.
authors.forename: Nilda M
authors.initials: NM
authors.lastname: Garcia
authors.affiliation: Dell Children's Medical Center, 4900 Mueller Blvd, Austin, TX 78723, USA.
authors.forename: Karla A
authors.initials: KA
authors.lastname: Lawson
authors.affiliation: The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK 73104, USA.
authors.forename: Prasenjeet
authors.initials: P
authors.lastname: Motghare
authors.affiliation: The Children's Hospital at OU Medical Center, 940 NE 13th St, #1b1306, Oklahoma City, OK 73104, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Letton
mesh_terms: D000293:Adolescent; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006305:Health Status Indicators; D006760:Hospitalization; D006801:Humans; D015601:Injury Severity Score; D008099:Liver / Q000293:injuries*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D013154:Spleen / Q000293:injuries*; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000628:therapy
keywords: Injury; Pediatric; SIPA; Shock index; Trauma