What question did this study set out to answer?

Evaluate the effectiveness of the pediatric age-adjusted shock index (SIPA) as an early predictor for hemorrhagic shock in pediatric trauma cases.

June 28, 2026

The role of shock index, pediatric age-adjusted, in early identification and management of hemorrhagic shock in pediatric trauma

Key Points

Evaluate the effectiveness of the pediatric age-adjusted shock index (SIPA) as an early predictor for hemorrhagic shock in pediatric trauma cases.
Retrospective cohort study of pediatric trauma patients admitted to Level 1 trauma centers between January 2017 and December 2023.
Utilized generalized linear models to analyze relationships between initial vital signs and outcomes.
Employed the Cox proportional hazard model to assess the SIPA's effect on blood transfusion timing.
Mortality was significantly higher in patients with ED hypotension (54.4% vs. 1.5%, p < 0.01).
SIPA associated with an 82% increase in time to blood transfusion initiation (4.5 vs. 17.8 h, p = 0.04).
Reduced hospital mortality linked to elevated SIPA (aOR, 0.42; 95% CI, 0.22–0.81, p = 0.01).

Abstract

BACKGROUND: Hemorrhagic shock is a leading cause of preventable pediatric trauma death, with hypotension representing a late, decompensated stage associated with high mortality. This study evaluates the shock index, pediatric age-adjusted (SIPA), as an early marker of compensated shock and a potential trigger for timely transfusion in pediatric trauma. METHODS: Retrospective cohort study in a large community hospital system (310, 000 annual emergency visits) of all pediatric (age <18 y) Level 1 trauma activations admitted from January 2017 through December 2023. Generalized linear models assessed the adjusted relationship between the initial vital signs and hospital outcomes. The Cox proportional hazard model assessed the effect of SIPA on time to blood transfusion. RESULTS: Among 601 pediatric trauma patients, the median age was 12. 2 years; 68. 7% were male, 41. 3% black, and 35. 1% white. Over half of all deaths (50. 7%) occurred in the emergency department (ED). Mortality was significantly higher among patients with hypotension on ED arrival (54. 4% vs. 1. 5%, p < 0. 01). ED hypotension adjusted odds ratio (aOR), 3. 93; 95% CI, 1. 05–14. 73 and ED transfusion (aOR, 5. 51; 95% CI, 2. 11–14. 36) independently predicted mortality. Although patients with initial ED hypotension had a shorter time to blood transfusion 3. 3 vs. 15. 5 h; hazard ratio, 1. 53 (95% CI, 0. 87–2. 72) ; p = 0. 14, hypotension in the ED remained a strong predictor of death. On the contrary, patients with an elevated SIPA experienced an 82% increase in time to blood transfusion initiation 4. 5 vs. 17. 8 h; p = 0. 04; hazard ratio, 1. 82 (95% CI, 1. 14–2. 90), p = 0. 01 and a reduction in hospital mortality aOR, 0. 42 (95% CI, 0. 22–0. 81), p = 0. 01. CONCLUSIONS: This finding supports the integration of SIPA into pediatric trauma resuscitation protocols to enhance early recognition and treatment of hemorrhagic shock. (J Trauma Acute Care Surg 2026;00: 000–000 Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved. ) LEVEL OF EVIDENCE: Therapeutic/Care Management; Level III. STUDY TYPE: Observational Cohort Study.

AI에게 질문

Bookmark