Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center
The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjust...
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MDPI AG
2021-08-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/8/8/688 |
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| author | Ya-Chih Yang Tsung-Han Hsieh Chi-Yuan Liu Chun-Yu Chang Yueh-Tseng Hou Po-Chen Lin Yu-Long Chen Da-Sen Chien Giou-Teng Yiang Meng-Yu Wu |
| author_facet | Ya-Chih Yang Tsung-Han Hsieh Chi-Yuan Liu Chun-Yu Chang Yueh-Tseng Hou Po-Chen Lin Yu-Long Chen Da-Sen Chien Giou-Teng Yiang Meng-Yu Wu |
| author_sort | Ya-Chih Yang |
| collection | DOAJ |
| description | The shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock progression. In the elevated SIPA group, more severe traumatic injuries were identified, including high injury severity score (ISS), revised trauma score (RTS), and new injury severity score (NISS) scores than SI > 0.9. The odds ratio of elevated SIPA and SI (>0.9) to predict ISS ≥ 16 was 3.593 (95% Confidence interval [CI]: 2.175–5.935, <i>p</i> < 0.001) and 2.329 (95% CI: 1.454–3.730, <i>p</i> < 0.001). SI and SIPA are useful for identifying the compensatory phase of shock in prehospital and hospital settings, especially in corresponding normal to low-normal blood pressure. SIPA is effective in predicting the mortality and severity of traumatic injuries in the pediatric population. However, SI and SIPA were not significant predictors of ICU admission and the need for surgery analysis. |
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| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-10T08:55:05Z |
| publishDate | 2021-08-01 |
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| record_format | Article |
| series | Children |
| spelling | doaj.art-f71697e7387e41e7b9bafa423dbbb4b42023-11-22T07:14:28ZengMDPI AGChildren2227-90672021-08-018868810.3390/children8080688Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single CenterYa-Chih Yang0Tsung-Han Hsieh1Chi-Yuan Liu2Chun-Yu Chang3Yueh-Tseng Hou4Po-Chen Lin5Yu-Long Chen6Da-Sen Chien7Giou-Teng Yiang8Meng-Yu Wu9Department of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Orthopedic Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Anesthesiology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanDepartment of Emergency Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei 231, TaiwanThe shock index (SI) is a useful tool for predicting the injury severity and mortality in patients with trauma. However, pediatric physiology differs from that of adults. In the pediatric trauma population, the shock status may be obscured within the normal range of vital signs. Pediatric age-adjusted SI (SIPA) is reported more accurately compared to SI. In our study, we conducted a 10 year retrospective cohort study of pediatric trauma population to evaluate the SI and SIPA in predicting mortality, intensive care unit (ICU) admission, and the need for surgery. This retrospective cohort study included 1265 pediatric trauma patients from January 2009 to June 2019 at the Taipei Tzu Chi Hospital, who had a history of hospitalization. The primary outcome of this investigation was in-hospital mortality, and the secondary outcomes were the length of hospital and ICU stay, operation times, and ICU admission times. The SIPA group can detect changes in vital signs early to reflect shock progression. In the elevated SIPA group, more severe traumatic injuries were identified, including high injury severity score (ISS), revised trauma score (RTS), and new injury severity score (NISS) scores than SI > 0.9. The odds ratio of elevated SIPA and SI (>0.9) to predict ISS ≥ 16 was 3.593 (95% Confidence interval [CI]: 2.175–5.935, <i>p</i> < 0.001) and 2.329 (95% CI: 1.454–3.730, <i>p</i> < 0.001). SI and SIPA are useful for identifying the compensatory phase of shock in prehospital and hospital settings, especially in corresponding normal to low-normal blood pressure. SIPA is effective in predicting the mortality and severity of traumatic injuries in the pediatric population. However, SI and SIPA were not significant predictors of ICU admission and the need for surgery analysis.https://www.mdpi.com/2227-9067/8/8/688shock indexpediatric age-adjusted shock indextraumapediatric traumamortality |
| spellingShingle | Ya-Chih Yang Tsung-Han Hsieh Chi-Yuan Liu Chun-Yu Chang Yueh-Tseng Hou Po-Chen Lin Yu-Long Chen Da-Sen Chien Giou-Teng Yiang Meng-Yu Wu Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center Children shock index pediatric age-adjusted shock index trauma pediatric trauma mortality |
| title | Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center |
| title_full | Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center |
| title_fullStr | Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center |
| title_full_unstemmed | Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center |
| title_short | Analysis of Clinical Outcome and Predictors of Mortality in Pediatric Trauma Population: Evidence from a 10 Year Analysis in a Single Center |
| title_sort | analysis of clinical outcome and predictors of mortality in pediatric trauma population evidence from a 10 year analysis in a single center |
| topic | shock index pediatric age-adjusted shock index trauma pediatric trauma mortality |
| url | https://www.mdpi.com/2227-9067/8/8/688 |
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