Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation

Background. We demonstrated previously that shock index, pediatric age-adjusted identifies severely injured children accurately after blunt trauma. We hypothesized that an increased shock index, pediatric age-adjusted would identify more accurately injured children requiring the highest trauma team activation than age-adjusted hypotension. Methods. We reviewed all children age 4-16 admitted after blunt trauma with an injury severity score 15 from January 2007 June 2013. Criteria used as indicators of need for activation of the trauma team included blood transfusion, emergency operation, or endotracheal intubation within 24 hours of admission. Shock index, pediatric age-adjusted represents maximum normal shock index based on age. Cutoffs included shock index > 1.22 (ages 4-6), > 1.0 (7-12), and >0.9 (13-16). Age-adjusted cutoffs for hypotension were as follows: systolic blood pressure <90 (ages 4-6), systolic blood pressure <100 (7-16). Results. A total of 559 children were included; 21 % underwent operation, 37% endotracheal intubation, and 14% transfusion. Hypotension alone predicted poorly the need for operation (13 %), endotracheal intubation (17%), or transfusion (22%). Operation (30%), endotracheal intubation (40%), and blood transfusion (53 %) were more likely in children with an increased shock index, pediatric age-adjusted; 25 children required all three interventions, 3 (12%) were hypotensive at presentation, 15 (60%) had an increased shock index, pediatric age-adjusted (P <.001). Conclusion. An increased shock index, pediatric age-adjusted is superior to age-adjusted hypotension to identify injured children likely to require emergency operation, endotracheal intubation, or early blood transfusion.