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 Camaren M.Cuenca;Matthew A.Borgman;Michael D.April;Andrew D.Fisher;Steven G.Schauer

作者机构：JUS Army Institute of Surgical Research3698 Chambers PassJBSA Fort Sam HoustonSan AntonioTX 78234-7767USA Brooke Army Medical CenterJBSA Fort Sam HoustonSan AntonioTXUSA Uniformed Services University of the Heath SciencesBethesdaMDUSA Texas Army National GuardAustinTXUSA Department of SurgeryUNM School of MedicineAlbuquerqueNMUSA 59th Medical WingJBSA LacklandSan AntonioTXUSA 

出 版 物：《Military Medical Research》 (军事医学研究（英文版）)

年 卷 期：2021年第8卷第1期

页      面：17-24页

核心收录：

学科分类：1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 100202[医学-儿科学] 100215[医学-康复医学与理疗学] 10[医学] 

主　　题：Pediatric Massive Transfusion Shock Index Age 

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 ***: 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 ***: 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 p