Pediatric Age-Adjusted Shock Index as a Predictor of Mortality by Sex Disparity in Pediatric Trauma: A Pan-Asian Trauma Outcome Study
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: There has been no report of sex-specific, pediatric age-adjusted shock index (PASI) for pediatric trauma patients in pre vious studies. We aimed to determine the association between the PASI and in-hospital mortality of pediatric trauma patients and whether this association differs depending on sex. Materials and Methods: This is a prospective, multinational, and multicenter cohort study using the Pan-Asian Trauma Outcome Study (PATOS) registry in the Asia-Pacific region, conducted in pediatric patients who visited the participating hospitals. The main exposure of our study was abnormal (elevated) PASI measured in an emergency department. The main outcome was in-hospital mortality. We performed a multivariable logistic regression analysis to estimate the association between abnormal PASI and study outcomes after adjusting for potential confounders. An interaction analysis between PASI and sex was also conducted. Results: Of 6280 pediatric trauma patients, 10.9% (686) of the patients had abnormal PASI. In multivariable logistic regression analysis, abnormal PASI was significantly associated with increased in-hospital mortality [adjusted odds ratios (aOR), 1.74; 95% confidence interval (CI), 1.13–2.47]. Abnormal PASI had interaction effects with sex for in-hospital mortality (aOR, 1.86; 95% CI, 1.19–2.91 and aOR, 1.38; 95% CI, 0.58–2.99 for male and female, respectively) (p<0.01). Conclusion: Abnormal PASI is associated with increased in-hospital mortality in pediatric trauma patients. The prediction power of PASI for in-hospital mortality was maintained only in male patients.
Abstract
Purpose: There has been no report of sex-specific, pediatric age-adjusted shock index (PASI) for pediatric trauma patients in pre vious studies. We aimed to determine the association between the PASI and in-hospital mortality of pediatric trauma patients and whether this association differs depending on sex. Materials and Methods: This is a prospective, multinational, and multicenter cohort study using the Pan-Asian Trauma Outcome Study (PATOS) registry in the Asia-Pacific region, conducted in pediatric patients who visited the participating hospitals. The main exposure of our study was abnormal (elevated) PASI measured in an emergency department. The main outcome was in-hospital mortality. We performed a multivariable logistic regression analysis to estimate the association between abnormal PASI and study outcomes after adjusting for potential confounders. An interaction analysis between PASI and sex was also conducted. Results: Of 6280 pediatric trauma patients, 10.9% (686) of the patients had abnormal PASI. In multivariable logistic regression analysis, abnormal PASI was significantly associated with increased in-hospital mortality [adjusted odds ratios (aOR), 1.74; 95% confidence interval (CI), 1.13–2.47]. Abnormal PASI had interaction effects with sex for in-hospital mortality (aOR, 1.86; 95% CI, 1.19–2.91 and aOR, 1.38; 95% CI, 0.58–2.99 for male and female, respectively) (p<0.01). Conclusion: Abnormal PASI is associated with increased in-hospital mortality in pediatric trauma patients. The prediction power of PASI for in-hospital mortality was maintained only in male patients.
참고문헌 (26)
- Ott R, "Prognostic value of trauma scores in pediatric patients with multiple injuries", J Trauma, 49, pp.729~736 (2000)
- Peden M, "The injury chart book: a graphical overview of the global burden of injuries", World Health Organization, ~ (2002)
- Acker SN, "Pediatric specific shock index accurately identifies severely injured children", J Pediatr Surg, 50, pp.331~334 (2015)
- Arshad A, "Trauma patients in the pediatric ICU : rational use of a limited resource", Curr Opin Pediatr, 32, pp.837~842 (2020)
- Vandromme MJ, "Identifying risk for massive transfusion in the relatively normotensive patient : utility of the prehospital shock index", J Trauma, 70, pp.384~388 (2011)
- Mutschler M, "The shock index revisited-a fast guide to transfusion requirement? A retrospective analysis on 21, 853 patients derived from the TraumaRegister DGU", Crit Care, 17, pp.R172~ (2013)
- Fröhlich M, "Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?-an analysis of the TraumaRegister DGU®", Scand J Trauma Resusc Emerg Med, 24, pp.148~ (2016)
- Cuenca CM, "Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan", Mil Med Res, 7, pp.33~ (2020)
- Marenco CW, "Validation of shock index pediatric-adjusted for children injured in warzones", J Trauma Acute Care Surg, 89, pp.642~648 (2020)
- Rappaport LD, "Ageand sex-specific normal values for shock index in national health and nutrition examination survey 1999-2008 for ages 8 years and older", Am J Emerg Med, 31, pp.838~842 (2013)
- Clarke WR, "Tracking of blood lipids and blood pressures in school age children : the Muscatine study", Circulation, 58, pp.626~634 (1978)
- Kong SY, "Pan-Asian Trauma Outcomes Study(PATOS) : rationale and methodology of an international and multicenter trauma registry", Prehosp Emerg Care, 22, pp.58~83 (2018)
- Ong ME, "Outcomes for out-of-hospital cardiac arrests across 7 countries in Asia : the Pan Asian Resuscitation Outcomes Study(PAROS)", Resuscitation, 96, pp.100~108 (2015)
- Nwomeh BC, "History and development of trauma registry : lessons from developed to developing countries", World J Emerg Surg, 1, pp.32~ (2006)
- Berdowski J, "Global incidences of out-of-hospital cardiac arrest and survival rates : systematic review of 67 prospective studies", Resuscitation, 81, pp.1479~1487 (2010)
- Behrman RE, "Nelson textbook of pediatrics" (2004), Saunders
- Dehn A, "Acute pre-hospital medicine : perspectives of an emergency medicine fellow and critical care paramedic", Emerg Med Australas, 32, pp.670~671 (2020)
- Naghibi T, "Inflammation and outcome in traumatic brain injury: does gender effect on survival and prognosis?", J Clin Diagn Res, 11, pp.PC06~PC09 (2017)
- Rousseaux J, "Prognostic value of shock index in children with septic shock", Pediatr Emerg Care, 29, pp.1055~1059 (2013)
- Yasaka Y, "Is shock index associated with outcome in children with sepsis", septic shock?*, 2013, pp.14, e372~e379
- Bruijns SR, "The value of traditional vital signs, shock index, and age-based markers in predicting trauma mortality", J Trauma Acute Care Surg, 74, pp.1432~1437 (2013)
- Avarello JT, "Pediatric major trauma : an approach to evaluation and management", Emerg Med Clin North Am, 25, pp.803~836 (2007)
- Keller MS, "Glasgow coma scale predicts coagulopathy in pediatric trauma patients", Semin Pediatr Surg, 10, pp.12~16 (2001)
- Spinella PC, "Resuscitation and transfusion principles for traumatic hemorrhagic shock", Blood Rev, 23, pp.231~240 (2009)
- Arbuthnot M, "Can we safely decrease intensive care unit admissions for children with high grade isolated solid organ injuries? Using the shock index, pediatric age-adjusted and hematocrit to modify APSA admission guidelines", J Pediatr Surg, 52, pp.989~992 (2017)
- Rapsomaniki E, "Blood pressure and incidence of twelve cardiovascular diseases : lifetime risks, healthy life-years lost, and agespecific associations in 1·25 million people", Lancet, 383, pp.1899~1911 (2014)