Use of Prehospital Reverse Shock Index Times Glasgow Coma Scale to Identify Children who Require the Most Immediate Trauma Care.

BACKGROUND: Appropriate prehospital trauma triage ensures transport of children to facilities that provide specialized trauma care. There is currently no objective and generalizable scoring tool for emergency medical services (EMS) to facilitate such decisions. An abnormal reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to be associated with severely injured children. This study sought to determine if rSIG could be used in the prehospital setting to identify injured children who require the highest levels of care.

METHODS: Patients (1-18 years old) transferred from the scene to a level 1 pediatric trauma center (PTC) from 2010 - 2020 with complete prehospital and emergency department (ED) vital signs and Glasgow Coma Scale scores were included. rSIG was calculated as previously described [(SBP/HR) x GCS], and the following cutoffs were used: ≤13.1, ≤16.5, and ≤ 20.1 for 1-6, 7-12, and 13-18 year old patients, respectively. Trauma activation level and clinical outcomes upon arrival to the PTC were collected.

RESULTS: There were 247 patients included in the analysis; 66.0% (163) had an abnormal prehospital rSIG. Patients with an abnormal rSIG had a higher rate of highest-level trauma activation compared to those with a normal rSIG (38.7% vs 20.2%, p = 0.013). Patients with an abnormal prehospital rSIG also had higher rates of intubation (28.8% vs 9.52%, p < 0.001), intracranial pressure (ICP) monitor (9.20 vs. 1.19%, p = 0.032), need for blood (19.6% vs 8.33%, p = 0.034), laparotomy (7.98% vs 1.19%, p = 0.039), and ICU admission (54.6% vs 40.5%, p = 0.049).

CONCLUSIONS: rSIG may assist EMS providers in early identification and triage of severely injured children. An abnormal rSIG in the ED is associated with higher rates of intubation, need for blood transfusion, ICP monitoring, laparotomy and ICU admission. Use of this metric may help to speed the identification, care and treatment of any injured child.

LEVEL OF EVIDENCE: Prognostic/epidemiological, III.