The Shock Index among Children Presenting to the Emergency Department: Analysis of Nationally Representative Sample

Background

The Shock Index (SI) is emerging as a potentially useful measure among children with injury or suspected sepsis.

Objective

The aim of this study was to evaluate the distribution of the SI and evaluate its association with clinical outcomes among all children presenting to the emergency department (ED).

Methods

A complex survey of nonfederal U.S. ED encounters from 2016 through 2021 was analyzed. Among children, the Pediatric Age-Adjusted Shock Index (SIPA), Pediatric Shock Index (PSI), and the Temperature- and Age-Adjusted Shock Index (TAMSI) were analyzed. The association of these criteria with disposition, acuity, medication administration, diagnoses and procedures was analyzed.

Results

A survey-weighted 81.5 million ED visits were included for children aged 4–16 years and 117.2 million visits were included for children aged 1–12 years. SI could be calculated for 78.6% of patients aged 4–16 years and 57.9% of patients aged 1–12 years. An abnormal SI was present in 15.9%, 11.1%, and 31.7% when using the SIPA, PSI, and TAMSI, respectively. With all criteria, an elevated SI was associated with greater hospitalization. The SIPA and PSI were associated with triage acuity. All criteria were associated with medical interventions, including provision of IV fluids and acquisition of blood cultures.

Conclusions

An elevated SI is indicative of greater resource utilization needs among children in the ED. When using any criteria, an elevated SI was associated with clinically important outcomes. Further research is required to evaluate the distribution of the SI in children and to investigate its potential role within existing triage algorithms for children in the ED.