The Recognition of Shock in Pediatric Trauma Patients

Purpose of Review Clinicians struggle to recognize shock in pediatric trauma patients because traditional markers used in adults (tachycardia and hypotension) are late findings in children. Once present, hypotension is indicative of a child in extremis and interventions, such as blood transfusion and hemorrhage control operation, may be too late to provide benefit. In the current review, we describe additional tools that clinicians can use to identify injured children in the early stages of shock, offering the opportunity for early resuscitation, hemorrhage control operation, and lower mortality rates. Recent Findings Shock index, pediatric-age adjusted (SIPA) was developed to identify severely injured pediatric trauma patients. An elevated SIPA score is associated with a higher injury severity score, blood transfusion, and ICU admission. Unlike SIPA, the Compensatory Reserve Index (CRI) was developed in adults. CRI is a continuous, noninvasive, individual-specific measure of compensation that provides real-time insight into central volume loss and fluid resuscitation effectiveness. Current work is investigating the utility of CRI in the evaluation and management of pediatric trauma patients. Summary Children can compensate for acute blood loss with little change in traditional vital signs, so tachycardia and hypotension in a child may be quickly followed by sudden, unexpected hemodynamic decompensation. Several pediatric specific tools have been developed to help clinicians recognize children at the onset of circulatory compromise versus the onset of decompensation. These include an objective assessment of capillary refill, repeated SIPA calculations, and trending CRI values. Familiarity with these tools can facilitate the early identification of children at risk for decompensation. Incorporating them into everyday practice and decision-making rules can expedite decisions to transfuse blood or perform hemorrhage control procedures.