Pediatric Adjusted Reverse Shock Index Multiplied by Glasgow Coma Scale as a Prospective Predictor for Mortality in Pediatric Trauma.

INTRODUCTION Shock index (SI) and its pediatric adjusted derivative (SIPA) have demonstrated utility as prospective predictors of mortality in adult and pediatric trauma populations. Although basic vital signs provide promise as triage tools, factors such as neurologic status on arrival have profound implications for trauma-related outcomes. Recently, the reverse SI (rSI) multiplied by Glasgow Coma Scale (GCS) (rSIG) has been validated in adult trauma as a tool combining early markers of physiology and neurologic function to predict mortality. This study sought to compare the performance characteristics of rSIG against SIPA as a prospective predictor of mortality in pediatric war zone injuries. METHODS Retrospective review of the Department of Defense Trauma Registry, 2008 - 2016, was performed for all patients less than 18 years old with documented vital signs and GCS on initial arrival to the trauma bay. Optimal age specific cut off values were derived for rSIG via the Youden Index using receiver operating characteristic analyses. Multivariate logistic regression was performed to validate accuracy in predicting early mortality. RESULTS A total of 2,007 pediatric patients with a median age range of 7-12, 79% male, average ISS 11.9, and 62.5% sustaining a penetrating injury were included in the analysis. The overall mortality was 7.1%. A total of 874 (43.5%) and 685 (34.1%) patients had elevated SIPA and pediatric rSIG scores, respectively. After adjusting for demographics, mechanism of injury, initial vital signs and presenting laboratory values, rSIG (OR=4.054; p=0.01) was found to be superior to SIPA (OR=2.742; p<0.01) as an independent predictor of early mortality. CONCLUSION rSIG more accurately identifies pediatric patients at highest risk of death when compared to SIPA alone, following war zone injuries. These findings may help further refine early risk assessments for patient management and resource allocation in constrained settings. Further validation is necessary to determine applicability to the civilian population.Prognostic StudyLevel of Evidence: Level IV.