Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

Background: The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an e...

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Autores principales:	Kuo-Chen Huang, Ying Yang, Chao-Jui Li, Fu-Jen Cheng, Ying-Hsien Huang, Po-Chun Chuang, I-Min Chiu
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	pediatric SIPA shock index mortality emergency department intensive care unit Pediatrics RJ1-570
Acceso en línea:	https://doaj.org/article/2f1d1a1b5bef47af81e093f6b453522f
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spelling	oai:doaj.org-article:2f1d1a1b5bef47af81e093f6b453522f2021-11-16T16:54:53ZShock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit2296-236010.3389/fped.2021.727466https://doaj.org/article/2f1d1a1b5bef47af81e093f6b453522f2021-09-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fped.2021.727466/fullhttps://doaj.org/toc/2296-2360Background: The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an early index of prognosis for non-traumatic children visiting the pediatric emergency department (ED) and were directly admitted to the intensive care unit (ICU). We hypothesized that an increase in SIPA values in the first 24 h of ICU admission would correlate with mortality and adverse outcomes.Methods: This multicenter retrospective study enrolled non-traumatic patients aged 1–17 years who presented to the pediatric ED and were directly admitted to the ICU from January 1, 2016, to December 31, 2018, in Taiwan. The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1–6), >1.0 (patient age: 7–12), and >0.9 (patient age: 12–17). The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes.Results: In total, 1,732 patients were included. Of these, 1,050 (60.6%) were under 6 years old, and the median Pediatric Risk of Mortality score was 7 (5–10). In total, 4.7% of the patients died, 12.9% received mechanical ventilator (MV) support, and 11.1% received inotropic support. The SIPA value at 24 h after admission was associated with increased mortality [odds ratio (OR): 4.366, 95% confidence interval (CI): 2.392–7.969, p < 0.001], MV support (OR: 1.826, 95% CI: 1.322–2.521, p < 0.001), inotropic support (OR: 2.306, 95% CI: 1.599–3.326, p < 0.001), and a long hospital length of stay (HLOS) (2.903 days, 95% CI: 1.734–4.271, p < 0.001). Persistent abnormal SIPA value was associated with increased mortality (OR: 2.799, 95% CI: 1.566–5.001, p = 0.001), MV support (OR: 1.457, 95% CI: 1.015–2.092, p = 0.041), inotropic support (OR: 1.875, 95% CI: 1.287–2.833, p = 0.001), and a long HLOS (3.2 days, 95% CI: 1.9–4.6, p < 0.001). Patients with abnormal to normal SIPA values were associated with decreased mortality (OR: 0.258, 95% CI: 0.106–0.627, p = 0.003), while patients with normal to abnormal SIPA values were associated with increased mortality (OR: 3.055, 95% CI: 1.472–5.930, p = 0.002).Conclusions: In non-traumatic children admitted to the ICU from the ED, increased SIPA values at 24 h after ICU admission predicted high mortality and bad outcomes. Monitoring the trends in the SIPA could help with prognostication and optimize early management.Kuo-Chen HuangYing YangChao-Jui LiFu-Jen ChengYing-Hsien HuangPo-Chun ChuangI-Min ChiuFrontiers Media S.A.articlepediatricSIPAshock indexmortalityemergency departmentintensive care unitPediatricsRJ1-570ENFrontiers in Pediatrics, Vol 9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	pediatric SIPA shock index mortality emergency department intensive care unit Pediatrics RJ1-570
spellingShingle	pediatric SIPA shock index mortality emergency department intensive care unit Pediatrics RJ1-570 Kuo-Chen Huang Ying Yang Chao-Jui Li Fu-Jen Cheng Ying-Hsien Huang Po-Chun Chuang I-Min Chiu Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
description	Background: The shock index, pediatric age-adjusted (SIPA), defined as the maximum normal heart rate divided by the minimum normal systolic blood pressure by age, can help predict the risk of morbidity and mortality after pediatric trauma. This study investigated whether the SIPA can be used as an early index of prognosis for non-traumatic children visiting the pediatric emergency department (ED) and were directly admitted to the intensive care unit (ICU). We hypothesized that an increase in SIPA values in the first 24 h of ICU admission would correlate with mortality and adverse outcomes.Methods: This multicenter retrospective study enrolled non-traumatic patients aged 1–17 years who presented to the pediatric ED and were directly admitted to the ICU from January 1, 2016, to December 31, 2018, in Taiwan. The SIPA value was calculated at the time of arrival at the ED and 24 h after ICU admission. Cutoffs included SIPA values >1.2 (patient age: 1–6), >1.0 (patient age: 7–12), and >0.9 (patient age: 12–17). The utility of the SIPA and the trends in the SIPA during the first 24 h of ICU admission were analyzed to predict outcomes.Results: In total, 1,732 patients were included. Of these, 1,050 (60.6%) were under 6 years old, and the median Pediatric Risk of Mortality score was 7 (5–10). In total, 4.7% of the patients died, 12.9% received mechanical ventilator (MV) support, and 11.1% received inotropic support. The SIPA value at 24 h after admission was associated with increased mortality [odds ratio (OR): 4.366, 95% confidence interval (CI): 2.392–7.969, p < 0.001], MV support (OR: 1.826, 95% CI: 1.322–2.521, p < 0.001), inotropic support (OR: 2.306, 95% CI: 1.599–3.326, p < 0.001), and a long hospital length of stay (HLOS) (2.903 days, 95% CI: 1.734–4.271, p < 0.001). Persistent abnormal SIPA value was associated with increased mortality (OR: 2.799, 95% CI: 1.566–5.001, p = 0.001), MV support (OR: 1.457, 95% CI: 1.015–2.092, p = 0.041), inotropic support (OR: 1.875, 95% CI: 1.287–2.833, p = 0.001), and a long HLOS (3.2 days, 95% CI: 1.9–4.6, p < 0.001). Patients with abnormal to normal SIPA values were associated with decreased mortality (OR: 0.258, 95% CI: 0.106–0.627, p = 0.003), while patients with normal to abnormal SIPA values were associated with increased mortality (OR: 3.055, 95% CI: 1.472–5.930, p = 0.002).Conclusions: In non-traumatic children admitted to the ICU from the ED, increased SIPA values at 24 h after ICU admission predicted high mortality and bad outcomes. Monitoring the trends in the SIPA could help with prognostication and optimize early management.
format	article
author	Kuo-Chen Huang Ying Yang Chao-Jui Li Fu-Jen Cheng Ying-Hsien Huang Po-Chun Chuang I-Min Chiu
author_facet	Kuo-Chen Huang Ying Yang Chao-Jui Li Fu-Jen Cheng Ying-Hsien Huang Po-Chun Chuang I-Min Chiu
author_sort	Kuo-Chen Huang
title	Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
title_short	Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
title_full	Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
title_fullStr	Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
title_full_unstemmed	Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit
title_sort	shock index, pediatric age-adjusted predicts morbidity and mortality in children admitted to the intensive care unit
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/2f1d1a1b5bef47af81e093f6b453522f
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Shock Index, Pediatric Age-Adjusted Predicts Morbidity and Mortality in Children Admitted to the Intensive Care Unit

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