Adding age-adjusted shock index to the American College of Surgeons' trauma team activation criteria to predict severe injury in children.
Adding age-adjusted shock index to the American College of Surgeons' trauma team activation criteria to predict severe injury in children.
复制标题
将年龄调整休克指数添加到美国外科医生学会的创伤团队激活标准中，以预测儿童的严重伤害。
DOI：
10.1097/ta.0000000000003693
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Gausche-Hill,Marianne
中科院分区：
文献类型：
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作者：
McCormick,Taylor;Haukoos,Jason;Hopkins,Emily;Trent,Stacy;Adelgais,Kathleen;Cohen,Mitchell;Gausche-Hill,Marianne
背景：美国外科医师学会(ACS)要求创伤中心使用六项最低标准(ACS-6)来激活完整的创伤团队。我们的目标是评估将年龄调整的休克指数(SI)添加到ACS-6中预测儿童创伤患者严重损伤的效果，假设SI可以显著提高敏感性，而特异性降低是可以接受的。方法我们对来自两个城市儿科创伤中心的前瞻性收集的EMS和创伤登记数据进行了二次分析。年龄调整的SI阈值是心率除以收缩压，使用2020儿科高级生命支持SI生命体征范围和先前发布的休克指数，儿科调整(SIPA)阈值。主要结果是紧急手术(到达后1小时内)或紧急程序干预(EOPI)或损伤严重程度评分(ISS)大于15的综合结果。单独计算了ACS-6的敏感性、特异性和95%的CI，并结合年龄调整的SI.结果纳入了8,078名患者；20%的患者年龄调整后SI升高，17%的患者至少满足一项ACS最低标准；1%的患者接受了EOPI；17%的患者有ISS>；15.ACS-6对EOPI或ISS>的敏感性和特异性；5为45%(95%可信区间，41~50%)和89%(95%可信区间，81~96%)。纳入儿科高级生命支持-SI和SIPA的敏感性分别为51%(95%CI，47-56%)和69%(95%CI，65-72%)，特异性分别为80%(95%CI，71-89%)和60%(95%CI，53-68%)。每个次要结果都有类似的趋势。结论
BACKGROUNDThe American College of Surgeons (ACS) requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation. Our goal was to evaluate the effect of adding age-adjusted shock index (SI) to the ACS-6 for the prediction of severe injury among pediatric trauma patients with the hypothesis that SI would significantly improve sensitivity with an acceptable decrease in specificity.METHODSWe performed a secondary analysis of prospectively collected EMS and trauma registry data from two urban pediatric trauma centers. Age-adjusted SI thresholds were calculated as heart rate divided by systolic blood pressure using 2020 Pediatric Advanced Life Support SI vital sign ranges and previously published Shock Index, Pediatric Adjusted (SIPA) thresholds. The primary outcome was a composite of emergency operative (within 1 hour of arrival) or emergency procedural intervention (EOPI) or Injury Severity Score (ISS) greater than 15. Sensitivities, specificities, and 95% CIs were calculated for the ACS-6 alone and in combination with age-adjusted SI.RESULTSThere were 8,078 patients included; 20% had an elevated age-adjusted SI and 17% met at least one ACS minimum criterion; 1% underwent EOPI; and 17% had ISS> 15. Sensitivity and specificity of the ACS-6 for EOPI or ISS> 5 were 45%(95% confidence interval [CI], 41–50%) and 89%(95% CI, 81–96%). Inclusion of Pediatric Advanced Life Support-SI and SIPA resulted in sensitivities of 51%(95% CI, 47–56%) and 69%(95% CI, 65–72%), and specificities of 80%(95% CI, 71–89%) and 60%(95% CI, 53–68%), respectively. Similar trends were seen for each secondary outcome.CONCLUSION