Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan

Camaren M. Cuenca; Matthew A. Borgman; Michael D. April; Andrew D. Fisher; Steven G. Schauer

doi:10.1186/s40779-020-00262-8

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Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan

RESEARCH | Updated：2023-02-28

- Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan
- Military Medical Research Vol. 8, Issue 1, Pages: 17-24(2021)
- Affiliations：
  
  1.US Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, San Antonio, TX 78234-7767, USA
  2.Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, TX, USA
  3.Uniformed Services University of the Heath Sciences, Bethesda, MD, USA
  4.Texas Army National Guard, Austin, TX, USA
  5.Department of Surgery, UNM School of Medicine, Albuquerque, NM, USA
  6.59th Medical Wing, JBSA Lackland, San Antonio, TX, USA
- Author bio：
  
  * Steven.g.schauer.mil@mail.mil
- Funds：
- DOI：10.1186/s40779-020-00262-8
  CLC：
- Published：2021-03
- Accepted：
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Cuenca et al.: Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan. Mil Med Res, 2020, 7: 33.
DOI：

Cuenca et al.: Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan. Mil Med Res, 2020, 7: 33. DOI： 10.1186/s40779-020-00262-8.

摘要

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 was 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 reported 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.

关键词

Keywords

references

Ott R , Krämer R , Martus P , Bussenius-Kammerer M , Carbon R , Rupprecht H . Prognostic value of trauma scores in pediatric patients with multiple injuries . J Trauma. 2000 ; 49 ( 4 ): 729 – 36 .

National Academies of Sciences E, Medicine . In: Berwick D , Downey A , Cornett E , editors . A national trauma care system: integrating military and civilian trauma systems to achieve zero preventable deaths after injury . Washington, DC : The National Academies Press ; 2016 . p. 530 .

Spinella PC , Borgman MA , Azarow KS . Pediatric trauma in an austere combat environment . Crit Care Med. 2008 ; 36 ( 7 ): S293 – 6 .

Patregnani JT , Borgman MA , Maegele M , Wade CE , Blackbourne LH , Spinella PC . Coagulopathy and shock on admission is associated with mortality for children with traumatic injuries at combat support hospitals . Pediatr Crit Care Med. 2012 ; 13 ( 3 ): 273 – 7 .

Pannell D , Poynter J , Wales PW , Tien H , Nathens AB , Shellington D . Factors affecting mortality of pediatric trauma patients encountered in Kandahar, Afghanistan . Can J Surg. 2015 ; 58 ( 3 Suppl 3 ): S141 – 5 .

Matos RI , Holcomb JB , Callahan C , Spinella PC . Increased mortality rates of young children with traumatic injuries at a US army combat support hospital in Baghdad, Iraq, 2004 . Pediatrics. 2008 ; 122 ( 5 ): e959 – 66 .

Borgman M , Matos RI , Blackbourne LH , Spinella PC . Ten years of military pediatric care in Afghanistan and Iraq . J Trauma Acute Care Surg. 2012 ; 73 ( 6 Suppl 5 ): S509 – 13 .

Vernon DD , Furnival RA , Hansen KW , Diller EM , Bolte RG , Johnson DG , et al . Effect of a pediatric trauma response team on emergency department treatment time and mortality of pediatric trauma victims . Pediatrics. 1999 ; 103 ( 1 ): 20 – 4 .

Marcin JP , Pollack MM . Triage scoring systems, severity of illness measures, and mortality prediction models in pediatric trauma . Crit Care Med. 2002 ; 30 ( 11 Suppl ): S457 – 67 .

Bruijns SR , Guly HR , Bouamra O , Lecky F , Lee WA . The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality . J Trauma Acute Care Surg. 2013 ; 74 ( 6 ): 1432 – 7 .

Vandromme MJ , Griffin RL , Kerby JD , McGwin G Jr , Rue LW 3rd , Weinberg JA . Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index . J Trauma. 2011 ; 70 ( 2 ): 384 – 8 .

Cannon CM , Braxton CC , Kling-Smith M , Mahnken JD , Carlton E , Moncure M . Utility of the shock index in predicting mortality in traumatically injured patients . J Trauma. 2009 ; 67 ( 6 ): 1426 – 30 .

Eichelberger MR , Gotschall CS , Sacco WJ , Bowman LM , Mangubat EA , Lowenstein AD . A comparison of the trauma score, the revised trauma score, and the pediatric trauma score . Ann Emerg Med. 1989 ; 18 ( 10 ): 1053 – 8 .

Acker SN , Ross JT , Partrick DA , Tong S , Bensard DD . Pediatric specific shock index accurately identifies severely injured children . J Pediatr Surg. 2015 ; 50 ( 2 ): 331 – 4 .

Nordin A , Coleman A , Shi J , Wheeler K , Xiang H , Acker S , et al . Validation of the age-adjusted shock index using pediatric trauma quality improvement program data . J Pediatr Surg. 2017 ; 53 ( 1 ): S0022–S3468(17)30645–0 .

Schauer SG , April MD , Hill GJ , Naylor JF , Borgman MA , De Lorenzo RA . Prehospital interventions performed on pediatric trauma patients in Iraq and Afghanistan . Prehosp Emerg Care. 2018 ; 22 ( 5 ): 624 – 9 .

Schauer SG , Hill GJ , Naylor JF , April MD , Borgman M , Bebarta VS . Emergency department resuscitation of pediatric trauma patients in Iraq and Afghanistan . Am J Emerg Med. 2018 ; 36 ( 9 ): 1540 – 4 .

Schauer SG , Wheeler AR , April MD , Gale HL , Becker TE , Hill GJ , et al . An analysis of the pediatric casualties undergoing massive transfusion in Iraq and Afghanistan . Am J Emerg Med. 2019 ; 38 ( 5 ): S0735-S6757(19)30454–1 .

Glenn MA , Martin KD , Monzon D , Nettles W , Rodriquez VM , Lovasz D , et al . Implementation of a combat casualty trauma registry . J Trauma Nurs. 2008 ; 15 ( 4 ): 181 – 4 .

O'Connell KM , Littleton-Kearney MT , Bridges E , Bibb SC . Evaluating the joint theater trauma registry as a data source to benchmark casualty care . Mil Med. 2012 ; 177 ( 5 ): 546 – 52 .

Schauer SG , Naylor JF , Oliver JJ , Maddry JK , April MD . An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan . Am J Emerg Med. 2019 ; 37 ( 1 ): 94 – 9 .

Schauer SG , Arana AA , Naylor JF , Hill GJ , April MD . Prehospital analgesia for pediatric trauma patients in Iraq and Afghanistan . Prehosp Emerg Care. 2018 ; 22 ( 5 ): 608 – 13 .

Schauer SG , April MD , Naylor JF , Oliver JJ , Cunningham CW , Fisher AD , et al . A descriptive analysis of data from the department of defense joint trauma system prehospital trauma registry . US Army Med Dep J. 2017 ;( 3–17 ): 92 – 7 .

Acker SN , Bredbeck B , Partrick DA , Kulungowski AM , Barnett CC , Bensard DD . Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation . Surgery. 2017 ; 161 ( 3 ): 803 – 7 .

Traynor MD Jr , Hernandez MC , Clarke DL , Kong VY , Habermann EB , Polites SF , et al . Utilization of age-adjusted shock index in a resource-strained setting . J Pediatr Surg. 2019 ; 54 ( 12 ): 2621 – 6 .

St-Louis E , Bracco D , Hanley J , Razek T , Baird R . Development and validation of a new pediatric resuscitation and trauma outcome (PRESTO) model using the U.S. National Trauma Data Bank . J Pediatr Surg. 2017 ; 53 ( 1 ): 136 – 40 .

Robinson JB , Smith MP , Gross KR , Sauer SW , Geracci JJ , Day CD , et al . Battlefield documentation of tactical combat casualty care in Afghanistan . US Army Med Dep J. 2016 ;( 2–16 ): 87 – 94 .

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