Prehospital Shock Index as a Predictive Metric for In-Hospital Outcomes in Children.
The Journal of surgical research · 2025-10-24 · Observational study
Abstract
INTRODUCTION: The shock index (SI) may improve the pediatric assessment of injured children. We evaluated the association between prehospital SI and in-hospital outcomes among injured children. METHODS: We conducted a retrospective cross-sectional analysis of injured children (<18 y) from a multiagency prehospital electronic record system (2018-2022). We evaluated the following three SI criteria: SI pediatric age-adjusted (SIPA), pediatric SI (PSI), and age-based Z-score derived (SIZ) cut points. We evaluated the association of each with in-hospital mortality, admission, and elevated injury severity score (ISS > 15). RESULTS: Among 49,079 injured children, 116 had mortality, 4773 were hospitalized, and 497 had an elevated ISS. Abnormal SI were observed in 24.1%, 14.4%, and 20.2% of SIPA, PSI, and SIZ, respectively. Elevated SI per SIPA (odds ratio [OR]: 2.50, 95% confidence interval [CI] 1.65-3.75) and PSI (OR 3.88, 95% CI 2.63-5.69) were associated with mortality. SIZ was associated with mortality for both elevated (OR 4.57, 95% CI 3.02-6.86) and depressed (OR: 5.03, 95% CI 2.66-8.16) SI. Admission was associated with elevated SI per SIPA (OR: 1.38), PSI (OR: 1.75), and SIZ (OR: 1.76, 95% CI 1.63-1.90) and with depressed SI per SIZ (OR: 1.41, 95% CI 1.26-1.57). Only a depressed SI under SIZ was associated with elevated ISS (OR: 1.40, 95% CI 1.26-1.57). All criteria demonstrated limited sensitivity (39.4-54.3% for mortality, 21.6-29.6% for admission, and 14.5-24.4% for elevated ISS). CONCLUSIONS: The SI is associated with the in-hospital outcomes of mortality and admission. However, all criteria demonstrated poor diagnostic accuracy for in-hospital outcomes, suggesting limited predictive value.