Age-adjusted shock index vs. reverse shock index multiplied by Glasgow Coma Scale to evaluate mortality in pediatric trauma: a systematic literature review and meta-analysis.

Early identification of high-risk pediatric trauma patients is essential for timely intervention. The Shock Index, Pediatric Age-adjusted (SIPA) and the reverse Shock Index multiplied by Glasgow Coma Scale (rSIG, including rSIM variants) are commonly studied physiologic scores that have not been systematically compared. This study evaluated and compared the performance of SIPA and rSIG/rSIM for predicting mortality in pediatric trauma, and secondarily, blood product transfusion and other resource-use outcomes.

This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD42025641021). Five databases were searched from inception to September 10, 2025. Observational studies including trauma patients younger than 18 years that reported SIPA and/or rSIG/rSIM in relation to mortality and/or secondary outcomes were eligible. Screening and data extraction were performed in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects models (DerSimonian-Laird, with restricted maximum likelihood sensitivity analysis) synthesized odds ratios (ORs). Subgroup analyses compared SIPA versus rSIG/rSIM, and publication bias was explored using funnel plots and Egger's test.

Thirty-three studies were included qualitatively. Fourteen studies (n = 352,871) contributed to the mortality meta-analysis. The pooled effect favored rSIG/rSIM over SIPA for mortality (OR for SIPA vs. rSIG/rSIM = 0.19; 95% CI, 0.08-0.42; P < 0.001), with substantial heterogeneity (I²=98.8%), which was markedly lower within the rSIG/rSIM subgroup (I²=22.6%) than SIPA (I²=99.0%; between-subgroup difference, P = 0.019). Eleven studies contributed to transfusion outcomes; both indices captured increased transfusion risk (OR for SIPA vs. rSIG/rSIM = 0.28; 95% CI, 0.18-0.42; P < 0.001), without a significant SIPA-rSIG/rSIM contrast (P = 0.149). Egger's tests did not suggest small-study effects for either outcome.

Indices incorporating neurologic status (rSIG/rSIM) showed a stronger and more consistent association with mortality than SIPA in pediatric trauma, supporting rSIG/rSIM for early mortality risk stratification when the Glasgow Coma Scale is reliably measured. SIPA remains informative for transfusion and resource-use enrichment.