The American College of Surgeons (ACS) announced a new study that finds that blood pressure thresholds that are commonly used to identify dangerously unstable vital signs in pediatric patients “may not signal trouble soon enough” after they suffer a traumatic injury.
The findings of the national study of more than 230,000 pediatric trauma patients, published as an article in press on the Journal of the American College of Surgeons website, “suggest clinicians may need to recognize and respond to signs of circulatory instability at higher blood pressure levels than current pediatric reference values indicate,” states ACS.
The researchers used the American College of Surgeons Trauma Quality Improvement Program (TQIP) database to analyze 233,490 injured children ages 1 to 15 treated at participating trauma centers between 2018 and 2023. “They identified the blood pressure, heart rate, and shock index values most strongly associated with death and compared them with pediatric thresholds currently used in clinical practice,” states ACS. Particularly, the researchers identified blood pressure and heart rate values that signify hemodynamic instability and compared them with previously known thresholds.
States ACS, “When researchers compared the trauma-derived thresholds with current Pediatric Advanced Life Support (PALS) and age-adjusted pediatric shock index (SIPA) reference values, they found:
ACS notes that the study could lead to refinement of the thresholds that are used to guide treatment of pediatric trauma patients: “Future research will need to determine whether revised values can improve outcomes for critically injured children,” it states, adding that the study drew data only from participating trauma centers, and “may not reflect all U.S hospitals, particularly those in rural or community hospital settings.”
“Recognizing hemodynamic instability is fundamental in trauma care because these vital signs tell us when a child may be at increased risk of death or complications and when we may need to intervene,” stated the study’s senior author, Zain G. Hashmi, MD, FACS, assistant professor of trauma and acute care surgery at the University of Alabama at Birmingham (UAB). “Blood pressure and heart rate often help determine when clinicians should begin resuscitative interventions, including a blood transfusion. However, commonly used pediatric reference values were not developed specifically for trauma patients and may not accurately reflect when the risk of death begins to rise in injured children.”
“Injured children are treated in emergency departments across the country, not only at pediatric trauma centers,” added the study’s lead author, Chandler A. Annesi, MD, a general surgery resident at UAB and lead author of the JACS study. “Providing clinicians with more accurate thresholds for recognizing instability could help them identify children at risk earlier and monitor them more closely.
“This research shows just how quickly an injured child’s condition can worsen after trauma,” stated Dr. Annesi. “Often, the pediatric literature suggests that a high heart rate is the first sign that a patient needs help. But by the time children get to the trauma bay, they may be past the point when they only exhibit a high heart rate, so we need to pay attention to their blood pressure, as well.”
“Trauma care is improved by research that challenges the status quo and defines clear parameters for organizing the most efficient, effective trauma care possible,” stated study co-author Jeffrey D. Kerby, MD, PhD, FACS, medical director of ACS Trauma Education, and director of the Division of Trauma and Acute Care Surgery at UAB. “This research provides an opportunity to use a data-driven approach to improve treatment for the most critically injured children.”
