RT Journal Article
SR Electronic
T1 Shock Index in the early assessment of febrile children at the emergency department: a prospective multicentre study
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP archdischild-2020-320992
DO 10.1136/archdischild-2020-320992
A1 Nienke N Hagedoorn
A1 Joany M Zachariasse
A1 Dorine Borensztajn
A1 Elise Adriaansens
A1 Ulrich von Both
A1 Enitan D Carrol
A1 Irini Eleftheriou
A1 Marieke Emonts
A1 Michiel van der Flier
A1 Ronald de Groot
A1 Jethro Adam Herberg
A1 Benno Kohlmaier
A1 Emma Lim
A1 Ian Maconochie
A1 Federico Martinón-Torres
A1 Ruud Gerard Nijman
A1 Marko Pokorn
A1 Irene Rivero-Calle
A1 Maria Tsolia
A1 Dace Zavadska
A1 Werner Zenz
A1 Michael Levin
A1 Clementien Vermont
A1 Henriette A Moll
A1 ,
YR 2021
UL http://adc.bmj.com/content/early/2021/06/28/archdischild-2020-320992.abstract
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.Data are available in a public, open access repository. A data set containing individual participant data will be made available in a public data repository containing a specific DOI. The data will be anonymised and will not contain any identifiable data. The data manager of the PERFORM consortium can be contacted for inquiries (Tisham.de@imperial.ac.uk).