375 - Pediatric Age-Adjusted Shock Index as a Clinical Predictor of Hospital Admission in Children Presenting to the Emergency Department

Poster Number: 375

Mishuka Adhikary, The Children's Hospital at Montefiore, Bronx, NY, United States; Ellen J. Silver, Albert Einstein College of Medicine, Bronx, NY, United States; Daniel M. Fein, The Children's Hospital at Montefiore, Teaneck, NJ, United States

Background: Shock index, defined as the ratio of heart rate to systolic blood pressure, has been shown to be a valuable prognostic tool when assessing shock severity and anticipating patient morbidity and mortality in trauma patients. Pediatric age-adjusted shock index (SIPA) has been validated in multiple studies to identify and predict mortality in children with blunt trauma. Recent research has shown that triage shock index calculated from the emergency department shows promise as a clinical metric in the adult population as a predictor of hospital admission and inpatient mortality. Literature regarding utility of age-adjusted shock index in the general pediatric population is lacking.

Objective: To determine whether triage pediatric age-adjusted shock index can be used to predict disposition from the pediatric emergency department (PED).

Design/Methods: This was a retrospective chart review of all patients aged 4-20 years who were either admitted or discharged from a quaternary care PED in 2019. Patients with incomplete charts, and triage vital signs missing heart rate or blood pressure were excluded. Initial shock index values were characterized as high or low as established in prior studies based on four separate age categories with different cutoff values. Association between high pediatric age-adjusted shock index and inpatient admission was evaluated overall and within age groups. Relationship of high pediatric age-adjusted shock index and clinical characteristics were also examined. Chi-square analysis was used for all comparisons.

Results: There were 29476 eligible PED patient encounters occurring in the study period, with 2979 (10.1%) resulting in hospital admission and 6422 (21.8%) with a high triage pediatric age-adjusted shock index. High triage pediatric age-adjusted shock index was associated with younger age ( < 12-year-old), male gender, and emergency severity index (ESI) level 1-2 (Table 1). High triage pediatric age-adjusted shock index was associated with significantly greater odds of hospital admission overall and within each age group (Table 2). Among admissions, high triage pediatric age-adjusted shock index was also associated with higher odds of pediatric intensive care unit admission (OR 3.2; 95% CI 2.5-4.3) and rapid response on the in-patient unit (OR 3.9; 95% CI 1.8-8.8). Conclusion(s): Elevated triage pediatric age-adjusted shock index is associated with higher odds of admission. Elevated triage pediatric age-adjusted shock index shows promise as a clinical metric in the general pediatric ED population and should be further studied.
Adhikary CVAdhikary CV PAS.pdf
Table 2. Association Between SIPA and Admission