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
- Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan
- 解放军医学杂志（英文版） 2021年8卷第1期页码：17-24
- 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
  中图分类号：
- 纸质出版：2021-03
- Accepted：
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Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan[J]. 解放军医学杂志（英文版）, 2021,8(1):17-24.

Cuenca et al.: Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan. Mil Med Res, 2020, 7: 33.
Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan[J]. 解放军医学杂志（英文版）, 2021,8(1):17-24. DOI： 10.1186/s40779-020-00262-8.

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

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