Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan
Abstract Background Pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. Previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in ch...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Military Medical Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40779-020-00262-8 |
| _version_ | 1819071708430073856 |
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| author | Camaren M. Cuenca Matthew A. Borgman Michael D. April Andrew D. Fisher Steven G. Schauer |
| author_facet | Camaren M. Cuenca Matthew A. Borgman Michael D. April Andrew D. Fisher Steven G. Schauer |
| author_sort | Camaren M. Cuenca |
| collection | DOAJ |
| description | Abstract Background Pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. Previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in children. We seek to determine if those previous findings are applicable to the deployed, combat trauma setting. Methods We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. This is a secondary analysis of casualties seeking to validate previously published data using the shock index, pediatric age-adjusted. We then used previously published thresholds to determine patients outcome for validation by age grouping, 1–3 years (1.2), 4–6 years (1.2), 7–12 years (1.0), 13–17 years (0.9). Results From January 2007 through January 2016 there were 3439 pediatric casualties of which 3145 had a documented heart rate and systolic pressure. Of those 502 (16.0%) underwent massive transfusion and 226 (7.2%) died prior to hospital discharge. Receiver operating characteristic (ROC) thresholds were inconsistent across age groups ranging from 1.0 to 1.9 with generally limited area under the curve (AUC) values for both massive transfusion and death prediction characteristics. Using the previously defined thresholds for validation, we report sensitivity and specificity for the massive transfusion by age-group: 1–3 (0.73, 0.35), 4–6 (0.63, 0.60), 7–12 (0.80, 0.57), 13–17 (0.77, 0.62). For death, 1–3 (0.75, 0.34), 4–6 (0.66–0.59), 7–12 (0.64, 0.52), 13–17 (0.70, 0.57). However, negative predictive values (NPV) were generally high with all greater than 0.87. Conclusions Within the combat setting, the age-adjusted pediatric shock index had moderate sensitivity and relatively poor specificity for predicting massive transfusion and death. Better scoring systems are needed to predict resource needs prior to arrival, that perhaps include other physiologic metrics. We were unable to validate the previously published findings within the combat trauma population. |
| first_indexed | 2024-12-21T17:26:08Z |
| format | Article |
| id | doaj.art-c084d43890bf497d83a50f8c2dcfeb2f |
| institution | Directory Open Access Journal |
| issn | 2054-9369 |
| language | English |
| last_indexed | 2024-12-21T17:26:08Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Military Medical Research |
| spelling | doaj.art-c084d43890bf497d83a50f8c2dcfeb2f2022-12-21T18:56:03ZengBMCMilitary Medical Research2054-93692020-07-01711710.1186/s40779-020-00262-8Validation of the age-adjusted shock index for pediatric casualties in Iraq and AfghanistanCamaren M. Cuenca0Matthew A. Borgman1Michael D. April2Andrew D. Fisher3Steven G. Schauer4US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam HoustonBrooke Army Medical Center, JBSA Fort Sam HoustonBrooke Army Medical Center, JBSA Fort Sam HoustonTexas Army National GuardUS Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam HoustonAbstract Background Pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. Previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in children. We seek to determine if those previous findings are applicable to the deployed, combat trauma setting. Methods We queried the Department of Defense Trauma Registry (DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. This is a secondary analysis of casualties seeking to validate previously published data using the shock index, pediatric age-adjusted. We then used previously published thresholds to determine patients outcome for validation by age grouping, 1–3 years (1.2), 4–6 years (1.2), 7–12 years (1.0), 13–17 years (0.9). Results From January 2007 through January 2016 there were 3439 pediatric casualties of which 3145 had a documented heart rate and systolic pressure. Of those 502 (16.0%) underwent massive transfusion and 226 (7.2%) died prior to hospital discharge. Receiver operating characteristic (ROC) thresholds were inconsistent across age groups ranging from 1.0 to 1.9 with generally limited area under the curve (AUC) values for both massive transfusion and death prediction characteristics. Using the previously defined thresholds for validation, we report sensitivity and specificity for the massive transfusion by age-group: 1–3 (0.73, 0.35), 4–6 (0.63, 0.60), 7–12 (0.80, 0.57), 13–17 (0.77, 0.62). For death, 1–3 (0.75, 0.34), 4–6 (0.66–0.59), 7–12 (0.64, 0.52), 13–17 (0.70, 0.57). However, negative predictive values (NPV) were generally high with all greater than 0.87. Conclusions Within the combat setting, the age-adjusted pediatric shock index had moderate sensitivity and relatively poor specificity for predicting massive transfusion and death. Better scoring systems are needed to predict resource needs prior to arrival, that perhaps include other physiologic metrics. We were unable to validate the previously published findings within the combat trauma population.http://link.springer.com/article/10.1186/s40779-020-00262-8PediatricMassiveTransfusionShockIndexAge |
| spellingShingle | Camaren M. Cuenca Matthew A. Borgman Michael D. April Andrew D. Fisher Steven G. Schauer Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan Military Medical Research Pediatric Massive Transfusion Shock Index Age |
| title | Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan |
| title_full | Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan |
| title_fullStr | Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan |
| title_full_unstemmed | Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan |
| title_short | Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan |
| title_sort | validation of the age adjusted shock index for pediatric casualties in iraq and afghanistan |
| topic | Pediatric Massive Transfusion Shock Index Age |
| url | http://link.springer.com/article/10.1186/s40779-020-00262-8 |
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