Age-adjusted shock index vs. reverse shock index multiplied by Glasgow Coma Scale to evaluate mortality in pediatric trauma: a systematic literature review and meta-analysis.
Natalia Alexandra Fonseca Páez, Álvaro Andrés Trujillo Ceballos, Javier Aguilar Mejía et al.
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In 30 seconds
This systematic review and meta-analysis compared the age-adjusted Shock Index (SIPA) with reverse Shock Index multiplied by Glasgow Coma Scale variants (rSIG/rSIM) for predicting outcomes in trauma patients younger than 18 years. Thirty-three observational studies were included qualitatively; 14 studies (n = 352,871) contributed mortality data. The pooled comparison favored rSIG/rSIM for mortality (OR for SIPA vs. rSIG/rSIM = 0.19; 95% CI, 0.08-0.42; P < 0.001), although heterogeneity was substantial. Both indices were associated with transfusion risk, with no significant difference between them.
Key findings
- For mortality, the pooled comparison favored rSIG/rSIM over SIPA (OR for SIPA vs. rSIG/rSIM = 0.19; 95% CI, 0.08-0.42; P < 0.001).
- Mortality heterogeneity was lower for rSIG/rSIM (I²=22.6%) than for SIPA (I²=99.0%; between-subgroup difference, P = 0.019).
- Both indices captured increased transfusion risk, without a significant difference between SIPA and rSIG/rSIM (P = 0.149).
Why it matters
Early risk stratification can help identify pediatric trauma patients who may need timely intervention. These pooled observational findings suggest that scores incorporating neurologic status may provide a more consistent mortality association than SIPA, while both approaches may help identify transfusion risk. The substantial heterogeneity in mortality results is important when interpreting comparisons across settings.
What to keep in mind
The evidence came from observational studies, and mortality results showed substantial heterogeneity, particularly for SIPA.