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Use of reverse shock index times Glasgow coma scale (rSIG) to determine need for transfer of pediatric trauma patients to higher levels of care

  • Marina L. Reppucci
    Correspondence
    Corresponding author at: Division of Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, Anschutz Medical Campus, Aurora, CO 80045, United States
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States

    Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
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  • Jenny Stevens
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States

    Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
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  • Emily Cooper
    Affiliations
    Children's Hospital Center for Research in Outcomes for Children's Surgery, Children's Hospital Colorado, Aurora, CO, United States
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  • Margo M. Nolan
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States
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  • Swati Jujare
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States
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  • Shannon N. Acker
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States

    Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
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  • Steven L. Moulton
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States

    Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States
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  • Denis D. Bensard
    Affiliations
    Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, United States

    Division of Pediatric Surgery, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, United States

    Department of Surgery, Denver Health Medical Center, Denver, CO, United States
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      Abstract

      Introduction

      Most children in the US live more than one hour from a Level 1 PTC. The Need For Trauma Intervention (NFTI) score was developed to assess trauma triage criteria and is dependent on whether someone requires one of six urgent interventions (NFTI+). We sought to determine if a novel scoring tool, rSIG, could predict NFTI and facilitate the transfer decision making process.

      Methods

      Children 1–18 years old transferred to our level 1 PTC from 2010 - 2020 with complete vital signs and Glasgow Coma Scale (GCS) score at the transferring facility were included. rSIG was calculated as previously described [(SBP/HR) x GCS], and the following cutoffs were used for each age group: ≤13.1, ≤16.5, and ≤20.1 for 1–6, 7–12, and 13–18 years, respectively. Clinical outcomes upon arrival to the PTC were collected to determine if patients met any NTFI criteria.

      Results

      A total of 456 patients met inclusion criteria. The proportion of patients with an abnormal rSIG was 60.1% (274) and 37.0% (169) were NFTI+. Patients with an abnormal rSIG had an odds ratio of 6.18 (95% CI: 3.90, 10.07), p < 0.001 of being NFTI+ compared to those with a normal rSIG.

      Conclusion

      Children with an abnormal rSIG are more likely to be NFTI+ and require higher levels of care, indicating this scoring tool can identify pediatric trauma patients who may benefit from expedited transfer. Incorporating rSIG into initial evaluation and triage of traumatically injured children may expedite the transfer decision making process and limit delays in transport to a PTC.

      Type of study

      Retrospective Comparative Study

      Level of evidence

      III

      Keywords

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