Abstract
Background
The elevated shock index, pediatric age-adjusted (SIPA) has been found to accurately
predict the need for blood transfusion in severely injured children. We sought to
determine the utility of monitoring sequential SIPA values from the prehospital setting
through the emergency department to identify children with a blunt liver or spleen
injury who will require a blood transfusion.
Methods
We conducted a retrospective review of children 1 to 18 years old admitted to a level-1
pediatric trauma center with any grade blunt liver or spleen injury between 2009 and
2019. Cohorts were stratified into those who received a blood transfusion within the
first 24 hours after injury and those who did not.
Results
A total of 477 children had a blunt liver or spleen injury during the study period,
of which 20% (95 of 477) received a blood transfusion within 24 hours of trauma center
arrival. Of those who received a blood transfusion, 75% (71 of 95) were transfused
within 6 hours of arrival at our center. Nearly 90% (84 of 95) of patients who received
blood had at least 1 elevated SIPA score in either setting (prehospital or emergency
department). Based on multivariable regression, an elevated SIPA score in either setting
was significantly associated with blood transfusion (odds ratio 7.8 (confidence interval
4.7–12.9, P = .002).
Conclusion
Elevated SIPA values in the prehospital setting and on emergency department arrival are associated with early blood transfusion. The
importance of this finding is that after serial SIPA values may assist in the early
identification of children with blunt liver or spleen injury who will require a blood
transfusion.
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Article info
Publication history
Published online: July 10, 2020
Accepted:
April 27,
2020
Footnotes
Ryan Phillips and Shannon Acker are co-first authors.
Steven Moulton and Denis Bensard are co-senior authors.
Identification
Copyright
© 2020 Published by Elsevier Inc.
