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Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A retrospective observational study

Ray, S; Cvetkovic, M; Lutman, DH; Brierley, J; Pathan, N; Inwald, D; Ramnarayan, P; (2016) Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A retrospective observational study. Shock , 46 (3) pp. 279-286. 10.1097/SHK.0000000000000634. Green open access

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Abstract

BACKGROUND: Shock index (SI) (heart rate/systolic blood pressure) has been used to predict outcome in both adult and pediatric sepsis within the intensive care unit (ICU). We aimed to evaluate the utility of SI prior to pediatric ICU (PICU) admission. METHODS: We conducted a retrospective observational study of children referred to a pediatric intensive care transport service (PICTS) between 2005 and 2011. The predictive value of SI, heart rate and blood pressure at three pre-specified time points (at referral to PICTS, at PICTS arrival at the referring hospital, and at PICU admission), and changes in SI between the time points, were evaluated. Death within the first 48 hours of ICU admission (early death) was the primary outcome variable. RESULTS: Over the seven-year period, 572 children with sepsis were referred to the PICTS. Thirty-nine children died prior to transport to a PICU, while 474 were transported alive. Adjusting for age, time-points and time duration in a multi-level regression analysis, SI was significantly higher in those who died early. There was a significant improvement in SI with the transport team in survivors but not in non-survivors. However, the predictive value of a change in SI for mortality was no better than either a change in heart rate or blood pressure. CONCLUSIONS: The absolute or change in SI does not predict early death any more than heart rate and systolic blood pressure individually in children with sepsis.

Type: Article
Title: Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A retrospective observational study
Location: US
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/SHK.0000000000000634
Publisher version: http://dx.doi.org/10.1097/SHK.0000000000000634
Language: English
Additional information: This is a non-final version of an article published in final form in Ray, S; Cvetkovic, M; Lutman, DH; Brierley, J; Pathan, N; Inwald, D; Ramnarayan, P; (2016) Shock Index Values and Trends in Pediatric Sepsis: Predictors or Therapeutic Targets? A retrospective observational study. Shock, 46 (3) pp. 279-286.
Keywords: Shock, sepsis, children, transport, predictors, physiology
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/1478260
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