Critical shock index, pediatric age-adjusted as a predictive statistic for ICU admission in pediatric trauma

Abstract

Introduction: Shock Index (SI), the ratio of heart rate (HEART RATE) to systolic blood pressure (SBP), has been described as a trauma index capable of predicting poor outcomes. We aim to develop age-appropriate cutoffs, the Critical Shock Index, Pediatric Age-Adjusted (CSI-PA), to anticipate the need for critical care in pediatric trauma patients.

Methods: The 2017-2020 National Trauma Data Bank was analyzed for data on patients ages 1-18 with SBP and HEART RATE measurements used to calculate SI. Receiver Operating Characteristic analysis was performed for age groups 1-3, 4-6, 7-12, and 13-18 to determine cutoffs maximizing SI predictability of ICU admission, the CSI-PA. Using the CSI-PA, an analysis of rates of blood transfusion, ventilator use, average ventilator time, ICU admission, ICU length of stay, and in-hospital mortality was performed for each age group.

Results: 478,917 patients were included, 120,399 (25.1 %) had abnormal CSI-PA values. CSI-PA cutoffs were 1.239, 1.045, 0.9496, and 0.823 for age groups 1-3, 4-6, 7-12, and 13-18, respectively, by ROC analysis. Comparing the populations by CSI-PA, statistically significant differences in rates of ICU admission (13.3 % vs. 25.1 %), median days of ICU admission [2 (2-4) Vs 3 (2-5)], ventilator use (4.2 % vs. 11.7 %), median days of ventilator use [2 (1-5) vs. 2 (1-6)], and mortality (0.6 % vs. 2.5 %) (all p-value <0.001).

Conclusion: CSI-PA is an effective quantitative measure for pediatric trauma patients to predict the need for treatment at a hospital with critical care capabilities. Elevated CSI-PA scores predict worse outcomes and are associated with longer ventilator use, longer ICU admission, and higher rates of mortality.

Keywords: Critical Shock Index-Pediatric Age Adjusted; Pediatric intensive care; Shock index; Trauma triage.