Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan  

作　　者：Camaren M.Cuenca Matthew A.Borgman Michael D.April Andrew D.Fisher Steven G.Schauer 

机构地区：[1]JUS Army Institute of Surgical Research,3698 Chambers Pass,JBSA Fort Sam Houston,San Antonio,TX 78234-7767,USA [2]Brooke Army Medical Center,JBSA Fort Sam Houston,San Antonio,TX,USA [3]Uniformed Services University of the Heath Sciences,Bethesda,MD,USA [4]Texas Army National Guard,Austin,TX,USA [5]Department of Surgery,UNM School of Medicine,Albuquerque,NM,USA [6]59th Medical Wing,JBSA Lackland,San Antonio,TX,USA

出　　处：《Military Medical Research》2021年第1期17-24,共8页军事医学研究（英文版）

摘　　要：Background: Pediatric casualties account for a notable proportion of encounters in the deployed setting based on the humanitarian medical care mission. Previously published data demonstrates that an age-adjust shock index may be a useful tool in predicting massive transfusion and death in children. We seek to determine if those previous findings are applicable to the deployed, combat trauma setting.Methods: We queried the Department of Defense Trauma Registry(DODTR) for all pediatric subjects admitted to US and Coalition fixed-facility hospitals in Iraq and Afghanistan from January 2007 to January 2016. This was a secondary analysis of casualties seeking to validate previously published data using the shock index, pediatric age adjusted. We then used previously published thresholds to determine patients outcome for validation by age grouping, 1–3 years(1.2), 4–6 years(1.2), 7–12 years(1.0), 13–17 years(0.9).Results: From January 2007 through January 2016 there were 3439 pediatric casualties of which 3145 had a documented heart rate and systolic pressure. Of those 502(16.0%) underwent massive transfusion and 226(7.2%) died prior to hospital discharge. Receiver operating characteristic(ROC) thresholds were inconsistent across age groups ranging from 1.0 to 1.9 with generally limited area under the curve(AUC) values for both massive transfusion and death prediction characteristics. Using the previously defined thresholds for validation, we reported sensitivity and specificity for the massive transfusion by age-group: 1–3(0.73, 0.35), 4–6(0.63, 0.60), 7–12(0.80, 0.57), 13–17(0.77, 0.62). For death, 1–3(0.75, 0.34), 4–6(0.66–0.59), 7–12(0.64, 0.52), 13–17(0.70, 0.57). However, negative predictive values(NPV) were generally high with all greater than 0.87.Conclusions: Within the combat setting, the age-adjusted pediatric shock index had moderate sensitivity and relatively poor specificity for predicting massive transfusion and death. Better scoring systems are needed to predict resource needs

关 键 词：PEDIATRIC MASSIVE TRANSFUSION Shock INDEX Age 

分 类 号：R72[医药卫生—儿科] R457.1[医药卫生—临床医学]