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    Shock Index, Pediatric Age-Adjusted (SIPA)

    Predicts mortality in children with blunt trauma.
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    INSTRUCTIONS

    Use in blunt trauma patients 4-16 years of age.

    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients 4-16 years old who have sustained blunt trauma.

    • Do not use in young infants, toddlers, or patients with penetrating trauma.

    • SIPA should be calculated on presentation to the emergency department.

    • Uptrending SIPA between the field and ED may predict poor outcomes but was not examined by the original authors.

    • The use of SIPA to predict morbidity and mortality following admission has not yet been validated. However, a prognostic study in the Journal of Pediatric Surgery (Vandewalle 2018) found that patients who developed an elevated SIPA within the first 24 hours of admission were at increased risk of complications compared to those whose SIPA remained normal throughout the first 48 hours of admission. In addition, time to normalize SIPA directly correlated with length of hospital and ICU stay.

    • Per the authors, the age-specific cutoffs originally chosen will require further validation in a second cohort.

    • Better differentiates severely injured children from those with mild injury than the Shock Index (SI). In the original study, an elevated SIPA was shown to identify approximately 25% of the most severely injured children, regardless of age, while SI >0.9 has been shown to identify anywhere from 32-71% of injured children, depending on age.

    • Being able to accurately identify severely injured children is critical in reducing the over-triage of children that have sustained injuries.

    • Elevated SIPA is associated with the following outcomes (Acker 2015; Nordin 2017):

      • Higher injury severity.

      • Need for blood transfusion in the first 24 hours.

      • Longer ICU and hospital length of stay.

      • Higher number of ventilator days.

      • Discharge to a rehabilitation facility.

      • Increased risk of mortality.

    years
    beats/min
    mm Hg

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Patients that present with an elevated SIPA are at higher risk of morbidity and mortality following blunt trauma. Early recognition and treatment in these cases, including a possible decision to transfer to a higher level of care, will improve outcomes in these children.

    Management

    • General management of pediatric blunt abdominal trauma includes primary and secondary survey and determination of extent, type, and severity of injury.

    • A thorough abdominal exam is extremely important as abdominal injuries are often not apparent on exam. The use of imaging may be warranted depending on exam findings.

    Critical Actions

    Remember that there is no value or finding that necessarily defines shock, and children can compensate more readily than adults. Hypotension is often a late finding in children with hypovolemic shock.

    Content Contributors
    • Christian Hietanen, DO
    About the Creator
    Dr. Shannon N. Acker
    Content Contributors
    • Christian Hietanen, DO