Interfacility Transport Shock Index Is Associated With Decreased Survival in Children.
Interfacility Transport Shock Index Is Associated With Decreased Survival in Children.
复制标题
设施间运输冲击指数与儿童存活率下降有关。
DOI：
10.1097/pec.0000000000001205
复制
发表时间：
2019
影响因子：
1.4
通讯作者：
Fink,ErickaL
中科院分区：
文献类型：
--
作者：
Jennings,RyanM;Kuch,BradleyA;Felmet,KathrynA;Orr,RichardA;Carcillo,JosephA;Fink,ErickaL
休克指数是心率与收缩压的比值，随年龄变化，与创伤后成人和败血症儿童的死亡率相关。我们评估了实用的休克指数预测败血症的诊断和生存的儿童需要interfacility运输到一个三级care.MethodsWe研究了1个月至21岁的儿童谁有至少2套的生命体征记录在interfacility运输到匹兹堡儿童医院由我们的重症监护运输团队。受试者分为4个年龄组：第1组（< 1岁）、第2组（1-3岁）、第3组（4-11岁）和第4组（≥ 12岁）。根据国际疾病分类第九次修订版的分类，将儿童分为脓毒症组和非脓毒症组。主要结果是生存出院。ResultsOf 3519儿童研究，493（14%）有败血症。初始休克指数随年龄增加而降低：第1组为1.45±0.42（均数±标准差），第2组为1.35±0.32，第3组为1.20±0.34，第4组为1.00±0.32（P< 0.001）。在所有年龄组中，脓毒症患儿的初始休克指数均高于非脓毒症患儿（均P< 0.05）。在单变量分析中，初始休克指数显示与生存相关的趋势（P= 0.05），但在多变量logistic回归中与生存无关。休克指数的最高四分位数与重症监护室入院posttransfer.ConclusionsIncreased休克指数在儿童需要intrafacility运输与医院出院诊断败血症，但不住院生存。
BackgroundShock index, the ratio of heart rate to systolic blood pressure that changes with age, is associated with mortality in adults after trauma and in children with sepsis. We assessed the utility of shock index to predict sepsis diagnosis and survival in children requiring interfacility transport to a tertiary care center.MethodsWe studied children aged 1 month to 21 years who had at least 2 sets of vital signs recorded during interfacility transport to the Children’s Hospital of Pittsburgh by our critical care transport team. Subjects were divided into 4 age groups: group 1 (< 1 year), group 2 (1–3 years), group 3 (4–11 years), and group 4 (≥ 12 years). Children were also grouped into sepsis or nonsepsis group based on the International Classification of Diseases, Ninth Revision categories. Primary outcome was survival to hospital discharge.ResultsOf 3519 children studied, 493 (14%) had sepsis. Initial shock index decreased with increasing age: group 1, 1.45±0.42 (mean±SD); group 2, 1.35±0.32; group 3, 1.20±0.34; and group 4, 1.00±0.32 (P< 0.001). Initial shock index was increased in children with sepsis versus those with no sepsis overall and in all age groups (all P< 0.05). Initial shock index showed a trend for association with survival in univariate analysis (P= 0.05) but was not associated with survival in a multivariable logistic regression. Highest quartile of shock index was associated with need for intensive care unit admission posttransport.ConclusionsIncreased shock index in children requiring intrafacility transport was associated with hospital discharge diagnosis of sepsis but not hospital survival.