TY - JOUR
T1 - Shock Index in the early assessment of febrile children at the emergency department
T2 - A prospective multicentre study
AU - Hagedoorn, Nienke N.
AU - Zachariasse, Joany M.
AU - Borensztajn, Dorine
AU - Adriaansens, Elise
AU - Von Both, Ulrich
AU - Carrol, Enitan D.
AU - Eleftheriou, Irini
AU - Emonts, Marieke
AU - Van Der Flier, Michiel
AU - De Groot, Ronald
AU - Herberg, Jethro Adam
AU - Kohlmaier, Benno
AU - Lim, Emma
AU - MacOnochie, Ian
AU - Martinón-Torres, Federico
AU - Nijman, Ruud Gerard
AU - Pokorn, Marko
AU - Rivero-Calle, Irene
AU - Tsolia, Maria
AU - Zavadska, Dace
AU - Zenz, Werner
AU - Levin, Michael
AU - Vermont, Clementien
AU - Moll, Henriette A.
N1 - Funding: This work was supported by the European Union’s Horizon 2020 research and innovation programme (grant agreement no. 668303), by the National Institute for Health Research (NIHR) Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University, and by NIHR Academic Clinical Fellowship award (ACL-2018-21-00 to RN).
Publisher Copyright: © © Author(s) (or their employer(s)) 2022
PY - 2022/1/20
Y1 - 2022/1/20
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85108608909&partnerID=8YFLogxK
U2 - 10.1136/archdischild-2020-320992
DO - 10.1136/archdischild-2020-320992
M3 - Article
C2 - 34158280
AN - SCOPUS:85108608909
SN - 0003-9888
VL - 107
SP - 116
EP - 122
JO - Archives of Disease in Childhood
JF - Archives of Disease in Childhood
IS - 2
ER -