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Validation of the Shock Index, Modified Shock Index, and Shock Index-Paediatric age-Adjusted (SIPA) for predicting length of stay and outcome in children admitted to a paediatric intensive care unit
Egyptian Pediatric Association Gazette Pub Date : 2022-04-01 , DOI: 10.1186/s43054-022-00103-4
Monish Nazar , Hemanth Kumar , Madhunandan Krishnegowda , Praveen Unki , Nandakumar Veerappa , Bharath Kumar Srinivas

Maintaining hemodynamic stability requires constant complex interaction between multiple vascular and extravascular factors. There are varieties of parameters that determine the same and few of them are used to predict the hemodynamic instability at earliest. Shock Index (SI), Modified Shock Index (MSI) and Shock Index-Pediatric age-Adjusted (SIPA) have been studied constantly in different clinical settings. They are best non-invasive measures for early prediction in resource poor setting or at community referral centers. We would like to compare the predictive value of each parameter in our tertiary care center. It was a retrospective study carried out in PICU of a tertiary care centre and includes data collected from 15 August 2019 to 14 August 2021 over a period of 2 years. We recorded demographic data, age, gender, final diagnosis, outcome, and length of stay in PICU. We compared Outcome (Survived/Expired) and length of stay with SI ≥ 0.7 or < 0.7, MSI ≥ 1.3 or < 1.3 and SIPA > 1.22 or < 1.22 (age 4–6 years) > 1 or < 1 (7–12 years) and > 0.9 or < 0.9 (13–16 years). This study includes 235 children who were admitted to PICU during study period. The median age was 8 years the median length of stay was 5 days and mortality rate being 11.48% (27). Median SI, MSI were 0.78, 1.6 respectively. 61.70% (145) of patients had SI > 0.7. Median value of SI for septic shock patients was 0.92 on admission. The mortality of the patients with SI > 0.7 was 13.10% (19) and those with MSI > 1.3 was 14.89% (21). Mortality in accordance with SIPA for ages 4–6 years, 7–12 years, and 13–16 years were 15.25% (9), 23% (9) and 19.23% (5) respectively. Basically, SIPA was designed to monitor post trauma cases but in our study we got significant correlation with outcome and length of stay in conditions other than trauma. The SI, MSI, and SIPA are simple bedside parameters may be used for prioritizing the patients who require strict monitoring on admission to PICU and intervention whenever required. These parameters were best in predicting the severity of sepsis and septic shock in comparison to other diagnosis. SIPA can be generalised for monitoring any high-risk case.

中文翻译:

休克指数、改良休克指数和休克指数 - 儿科年龄调整 (SIPA) 的验证用于预测入住儿科重症监护病房的儿童的住院时间和结果

维持血流动力学稳定性需要多种血管和血管外因素之间不断复杂的相互作用。有多种参数可以确定相同的参数,其中很少有最早用于预测血流动力学不稳定性的参数。休克指数 (SI)、改良休克指数 (MSI) 和休克指数-儿科年龄调整 (SIPA) 已在不同的临床环境中不断进行研究。它们是在资源贫乏环境或社区转诊中心进行早期预测的最佳非侵入性措施。我们想比较我们三级护理中心每个参数的预测值。这是一项在三级护理中心的 PICU 进行的回顾性研究,包括从 2019 年 8 月 15 日至 2021 年 8 月 14 日在 2 年内收集的数据。我们记录了人口统计数据、年龄、性别、最终诊断、结果、和在 PICU 的停留时间。我们比较了 SI ≥ 0.7 或 < 0.7、MSI ≥ 1.3 或 < 1.3 和 SIPA > 1.22 或 < 1.22(4-6 岁)> 1 或 <1(7-12 岁)的结果(存活/过期)和住院时间) 和 > 0.9 或 < 0.9 (13-16 岁)。本研究包括在研究期间入住 PICU 的 235 名儿童。中位年龄为 8 岁,中位住院时间为 5 天,死亡率为 11.48% (27)。中位数 SI、MSI 分别为 0.78、1.6。61.70% (145) 的患者 SI > 0.7。感染性休克患者入院时的 SI 中位数为 0.92。SI > 0.7 的患者死亡率为 13.10% (19),MSI > 1.3 的患者死亡率为 14.89% (21)。根据 SIPA,4-6 岁、7-12 岁和 13-16 岁的死亡率分别为 15.25% (9)、23% (9) 和 19.23% (5)。基本上,SIPA 旨在监测创伤后病例,但在我们的研究中,我们得到了与创伤以外条件下的结果和停留时间的显着相关性。SI、MSI 和 SIPA 是简单的床边参数,可用于优先考虑在入院时需要严格监测并在需要时进行干预的患者。与其他诊断相比,这些参数在预测脓毒症和感染性休克的严重程度方面最好。SIPA 可以推广用于监控任何高风险案例。与其他诊断相比,这些参数在预测脓毒症和感染性休克的严重程度方面最好。SIPA 可以推广用于监控任何高风险案例。与其他诊断相比,这些参数在预测脓毒症和感染性休克的严重程度方面最好。SIPA 可以推广用于监控任何高风险案例。
更新日期:2022-04-01
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