- Design
- Systematic review and meta-analysis of observational studies
- Population
- 14 studies, 352,871 trauma patients under 18 (mortality analysis)
- Primary outcome
- Mortality prediction by SIPA vs rSIG/rSIM
- Effect
- OR for SIPA vs rSIG/rSIM 0.19 (95% CI 0.08–0.42); rSIG I² 22.6% vs SIPA 99%
This meta-analysis compared two physiological scores used to triage injured children. The age-adjusted paediatric shock index (SIPA) uses heart rate and systolic pressure. The reverse shock index multiplied by Glasgow Coma Scale (rSIG) adds neurological status. Fourteen observational studies with 352,871 children contributed to the mortality analysis.
rSIG was more strongly associated with mortality than SIPA, and its results were consistent across studies (I² 22.6%) whereas SIPA's varied enormously (I² 99%). Both identified children likely to need transfusion, without a clear difference.
For emergency teams, adding the GCS to the shock index sharpens recognition of the child at risk of dying, especially with head injury. SIPA remains useful for anticipating blood product needs.
- Consider rSIG (reverse shock index × GCS) for early mortality risk in injured children when GCS is reliable.
- Use the age-adjusted shock index to anticipate transfusion need.
- Calculate both from the first set of vital signs; neither needs laboratory results.
- Neither score replaces clinical judgement or a structured primary survey.
Why it matters
Simple bedside scores guide triage and activation of trauma teams, and this suggests which one to trust for mortality.
Don't overread it
All included studies were observational, and overall heterogeneity was very high.
The statistics, in plain English
I² measures how much studies disagree: 22.6% is low, 99% is extreme. The rSIG studies agreed with each other; the SIPA studies did not, so its pooled estimate is less trustworthy.
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