- Design
- Systematic review and meta-analysis of observational studies
- Population
- 352,871 injured children under 18 in 14 mortality studies
- Primary outcome
- Association of SIPA and rSIG with mortality
- Effect
- OR SIPA vs rSIG 0.19 (0.08–0.42); I² 22.6% for rSIG vs 99.0% for SIPA
A meta-analysis in Pediatric Surgery International compared two physiological scores in injured children: the age-adjusted shock index (SIPA) and the reverse shock index multiplied by Glasgow Coma Scale (rSIG). Fourteen observational studies with 352,871 children contributed to the mortality analysis.
rSIG was more strongly associated with death than SIPA (OR for SIPA versus rSIG 0.19), and its results were far more consistent across studies (I² 22.6% versus 99.0%). Both scores identified children likely to need transfusion, with no significant difference between them.
Heart rate and blood pressure alone miss the injured child whose main threat is the brain. Adding GCS makes the index reflect the commonest cause of paediatric trauma death.
Both scores are quick to calculate at the bedside. Use rSIG for early mortality risk where GCS can be reliably assessed, and SIPA to anticipate transfusion.
- Calculate a reverse shock index times GCS for injured children when GCS can be reliably measured
- Use the age-adjusted shock index to anticipate transfusion needs
- Do not rely on either score where GCS is confounded by sedation or intubation
- Use these scores to support, not replace, primary survey judgement
Why it matters
It adds the brain to a triage score built only on heart rate and blood pressure.
Don't overread it
Pooled observational studies with very high overall heterogeneity; this is association, not validated triage performance.
The statistics, in plain English
The very high I² for SIPA means its association with death varied enormously between studies; the low I² for rSIG means its results were consistent, which matters as much as the size of the effect.
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