The rSIG Score Predicts Intensive Care Unit Admission and Blood Transfusion in Pediatric Trauma Patients.

BACKGROUND

The aim of this study was to compare the values of the Age-Adjusted Pediatric Shock Index (SIPA), Reverse Shock Index (rSI), and the index obtained by multiplying the Reverse Shock Index by the Glasgow Coma Scale (rSIG) in predicting prognosis and transfusion requirements in pediatric multitrauma patients.

METHODS

In this retrospective observational study, 168 patients presenting with multiple pediatric trauma com-plaints to the Emergency Medicine Clinic of Başakşehir Çam and Sakura City Hospital between June 1, 2020, and June 1, 2022, were evaluated. Patients were divided into two groups based on their rSIG values: normal (n = 85) and abnormal (n = 83). rSIG classification was performed using age-specific cutoff points (1 - 6 years: ≤ 13.1, 7 - 12 years: ≤ 16.5, 13 - 17 years: ≤ 20.1). ROC analysis was performed for intensive care unit (ICU) admission, transfusion requirement, and surgical intervention.

RESULTS

The AUC value of rSIG in predicting ICU admission was 0.811 (95% CI: 0.719 - 0.903), which was significantly superior to rSI (AUC: 0.664) and SIPA (AUC: 0.623) (p < 0.001). The AUC value of rSIG in predicting transfusion requirement was 0.861 (95% CI: 0.767 - 0.956), while it was 0.610 (95% CI: 0.524 - 0.696) for surgical intervention. In the logistic regression analysis, each 1-point increase in rSIG reduced the odds ratio for ICU admission by 0.78 (OR: 0.780, 95% CI: 0.652 - 0.933, p = 0.006).

CONCLUSIONS

rSIG demonstrated significantly higher discriminatory power than SIPA and rSI for predicting ICU admission. Although rSIG showed higher AUC values for transfusion requirement and surgical intervention, these differences did not reach statistical significance. Nevertheless, rSIG may serve as a practical tool for rapid risk stratification and to transfer decisions in emergency departments, particularly for identifying patients requiring ICU admission.