背景:当受伤的患者到达急诊科(ED)时,及时和适当的护理至关重要。休克指数儿科年龄调整(SIPA)已被证明可以准确识别需要紧急干预的儿科患者。然而,没有研究评估SIPA对年龄校正性心动过速(AT)的作用.这项研究旨在将SIPA与AT在预测死亡率等结果方面进行比较。重伤,以及儿科创伤患者紧急干预的必要性。
方法:这是从2013-2020年创伤质量改善计划参与者使用文件(TQIPPUFs)提取的患者数据的回顾性横断面分析。包括4-16岁的患者,其损伤机制钝,损伤严重程度评分(ISS)>15。36,517名儿童符合这一标准。灵敏度,特异性,过度审判,并计算了未分诊率,以比较AT和升高的SIPA作为严重损伤和需要紧急干预的预测因子的有效性.紧急干预措施包括开颅手术,气管插管,开胸手术,剖腹手术,或胸管放置在24小时内到达。
结果:AT将59%的患者归类为“高风险”,“而SIPA提高了26%。与AT患者相比,SIPA升高的患者在24小时内需要输血的比例更高(22%vs.12%,分别为;p<0.001)。SIPA升高组的住院死亡率高于AT(10%vs.5%,分别;p<0.001)以及对紧急手术干预的需求(43%vs.分别为32%;p<0.001)。在SIPA升高患者中,需要输血的3级或更高肝/脾撕裂伤也比AT患者更常见(8%vs.4%,分别为;p<0.001)。在所有结果中,与SIPA相比,AT表现出更高的敏感性,但特异性较低。与SIPA相比,AT显示出过审和过审比率提高,但这归因于确定样本中有很大一部分是“高风险”。\"
结论:AT在死亡率敏感性方面优于SIPA,儿童创伤患者的损伤严重程度和紧急干预措施,而SIPA在这些结局中的特异性很高。
BACKGROUND: When an injured patient arrives in the Emergency Department (ED), timely and appropriate care is crucial. Shock Index Pediatric Age-Adjusted (SIPA) has been shown to accurately identify pediatric patients in need of emergency interventions. However, no study has evaluated SIPA against age-adjusted
tachycardia (AT). This study aims to compare SIPA with AT in predicting outcomes such as mortality, severe injury, and the need for emergent intervention in pediatric trauma patients.
METHODS: This is a retrospective cross-sectional analysis of patient data abstracted from the Trauma Quality Improvement Program Participant Use Files (TQIP PUFs) for years 2013-2020. Patients aged 4-16 with blunt mechanism of injury and injury severity score (ISS) > 15 were included. 36,517 children met this criteria. Sensitivity, specificity, overtriage, and undertriage rates were calculated to compare the effectiveness of AT and elevated SIPA as predictors of severe injuries and need for emergent intervention. Emergent interventions included craniotomy, endotracheal intubation, thoracotomy, laparotomy, or chest tube placement within 24 h of arrival.
RESULTS: AT classified 59% of patients as \"high risk,\" while elevated SIPA identified 26%. Compared to AT patients, a greater proportion of patients with elevated SIPA required a blood transfusion within 24 h (22% vs. 12%, respectively; p < 0.001). In-hospital mortality was higher for the elevated SIPA group than AT (10% vs. 5%, respectively; p < 0.001) as well as the need for emergent operative interventions (43% vs. 32% respectively; p < 0.001). Grade 3 or higher liver/spleen lacerations requiring blood transfusion were also more common among elevated SIPA patients than AT patients (8% vs. 4%, respectively; p < 0.001). AT demonstrated greater sensitivity but lower specificity compared to SIPA across all outcomes. AT showed improved overtriage and undertriage rates compared to SIPA, but this is attributed to identifying a large proportion of the sample as \"high risk.\"
CONCLUSIONS: AT outperforms SIPA in sensitivity for mortality, injury severity and emergent interventions in pediatric trauma patients while the specificity of SIPA is high across these outcomes.