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Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study

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Title: Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study
Authors: Hagedoorn, NN
Zachariasse, JM
Borensztajn, D
Adriaansens, E
Von Both, U
Carrol, ED
Eleftheriou, I
Emonts, M
Van der Flier, M
De Groot, R
Herberg, JA
Kohlmaier, B
Lim, E
Maconochie, I
Martinón-Torres, F
Nijman, RG
Pokorn, M
Rivero-Calle, I
Tsolia, M
Zavadska, D
Zenz, W
Levin, M
Vermont, C
Moll, HA
PERFORM consortium
Item Type: Journal Article
Abstract: OBJECTIVE: (1) To derive reference values for the Shock Index (heart rate/systolic blood pressure) based on a large emergency department (ED) population of febrile children and (2) to determine the diagnostic value of the Shock Index for serious illness in febrile children. DESIGN/SETTING: Observational study in 11 European EDs (2017-2018). PATIENTS: Febrile children with measured blood pressure. MAIN OUTCOME MEASURES: Serious bacterial infection (SBI), invasive bacterial infection (IBI), immediate life-saving interventions (ILSIs) and intensive care unit (ICU) admission. The association between high Shock Index (>95th centile) and each outcome was determined by logistic regression adjusted for age, sex, referral, comorbidity and temperature. Additionally, we calculated sensitivity, specificity and negative/positive likelihood ratios (LRs). RESULTS: Of 5622 children, 461 (8.2%) had SBI, 46 (0.8%) had IBI, 203 (3.6%) were treated with ILSI and 69 (1.2%) were ICU admitted. High Shock Index was associated with SBI (adjusted OR (aOR) 1.6 (95% CI 1.3 to 1.9)), ILSI (aOR 2.5 (95% CI 2.0 to 2.9)), ICU admission (aOR 2.2 (95% CI 1.4 to 2.9)) but not with IBI (aOR: 1.5 (95% CI 0.6 to 2.4)). For the different outcomes, sensitivity for high Shock Index ranged from 0.10 to 0.15, specificity ranged from 0.95 to 0.95, negative LRs ranged from 0.90 to 0.95 and positive LRs ranged from 1.8 to 2.8. CONCLUSIONS: High Shock Index is associated with serious illness in febrile children. However, its rule-out value is insufficient which suggests that the Shock Index is not valuable as a screening tool for all febrile children at the ED.
Issue Date: 20-Jan-2022
Date of Acceptance: 6-Jun-2021
URI: http://hdl.handle.net/10044/1/90305
DOI: 10.1136/archdischild-2020-320992
ISSN: 0003-9888
Publisher: BMJ Publishing Group
Start Page: 116
End Page: 122
Journal / Book Title: Archives of Disease in Childhood
Volume: 107
Issue: 2
Replaces: 10044/1/90302
http://hdl.handle.net/10044/1/90302
Copyright Statement: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
Sponsor/Funder: National Institute of Health and Medical Research
European Commission
Funder's Grant Number: CL-2018-21-007
Horizon 2020
Keywords: Science & Technology
Life Sciences & Biomedicine
Pediatrics
epidemiology
physiology
ADJUSTED SIPA
MORTALITY
TRAUMA
INFECTION
BACTERIAL
ACCURACY
SEPSIS
epidemiology
physiology
Blood Pressure
Child
Child, Preschool
Emergency Service, Hospital
Female
Fever
Heart Rate
Humans
Logistic Models
Male
Prospective Studies
Reference Values
Shock
PERFORM consortium
Humans
Shock
Fever
Logistic Models
Prospective Studies
Blood Pressure
Heart Rate
Reference Values
Child
Child, Preschool
Emergency Service, Hospital
Female
Male
epidemiology
physiology
Pediatrics
1103 Clinical Sciences
1114 Paediatrics and Reproductive Medicine
1117 Public Health and Health Services
Publication Status: Published
Conference Place: England
Online Publication Date: 2021-06-22
Appears in Collections:Department of Infectious Diseases
Faculty of Medicine



This item is licensed under a Creative Commons License Creative Commons