Title : Validity of the pediatric age-adjusted shock index in the early assessment of shock among patients with sepsis: A five-year review
Abstract:
Introduction: Managing patients admitted to the PICU involves early detection and treatment of shock and hemodynamic stability. Various vascular and extravascular elements must constantly interact to maintain hemodynamic stability. These have been the basis of pediatric age-adjusted shock index parameters. This study aims to determine the validity of the Pediatric Age-Adjusted Shock Index in predicting shock among pediatric patients with sepsis.
Methodology: This was a retrospective cross-sectional study that reviewed and analyzed the records of pediatric patients with sepsis and SIRS on admission from January 2018 to December 2022 in a tertiary hospital in Makati City, Philippines. Patient records were reviewed, and relevant data was obtained, including clinical-sociodemographic variables, vital signs, diagnoses, diagnostics done, the use of inotropes, the occurrence of shock, and mortality. The Pediatric Age-Adjusted Shock Index's sensitivity, specificity, predictive values, and accuracy were computed.
Results: A total of 117 patients with systemic inflammatory response syndrome were included. No significant association was observed between the occurrence of septic shock and age-adjusted shock index classification at admission (p = 0.522) and 4 hours (p = 0.534). Also, no significant association was observed between mortality and age-adjusted shock index classification at admission (p = 0.288) and 4 hours (p = 0.509). In contrast, a significant association was observed between age-adjusted shock index classification at 6 hours and septic shock (p = 0.029) and mortality (p = 0.010). The prognostic accuracy in predicting septic shock is as follows: at admission = 46.9% (sensitivity = 66.7%, specificity = 34.8%), at 4 hours = 45.2% (sensitivity = 71.1%, specificity = 30.3%), and 6 hours = 53.6% (sensitivity = 80.6%, specificity = 40.9%). The prognostic factors in predicting mortality are as follows: at admission, 48.3% (sensitivity = 74.3%, specificity = 37.0%); at 4 hours, 42.6% (sensitivity = 71.9%, specificity = 30.3%); and at 6 hours, 53.5% (sensitivity = 85.7%, specificity = 41.1%).
Conclusion: The Pediatric Age-Adjusted Shock Index showed good sensitivity but poor specificity, indicating it can correctly identify most high-risk patients who will develop shock and mortality. It may also incorrectly identify low-risk patients as high-risk. While the Pediatric Age-Adjusted Shock Index can screen high-risk patients, prioritizing limited hospital resources for low-risk patients incorrectly identified by the tool is inefficient. It is recommended to use this tool in conjunction with other factors, such as diagnostic tests, and to look for other tools that will yield better prognostic accuracy in predicting shock and mortality in septic children.
