rSIG and rSIM indices show stronger association with mortality than SIPA in pediatric traumaNew Tool Shows Better Way to Predict Pediatric Trauma Mortality

Pediatric surgery international Published October 10, 2026 Study authors: Fonseca Páez Natalia Alexandra, Trujillo Ceballos Álvaro Andrés, Aguilar Mejía Javier, Cañón Plazas … PubMed ↗ DOI ↗ Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

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Key Takeaway

Note that rSIG/rSIM indices show a stronger association with mortality than SIPA in pediatric trauma patients.

This meta-analysis of observational studies evaluates the performance of the Pediatric Age-adjusted (SIPA) index versus the reverse Shock Index multiplied by Glasgow Coma Scale (rSIG, including rSIM variants) for mortality risk stratification in pediatric trauma patients. The analysis included a total of 352,871 patients.

The pooled results indicate that the rSIG/rSIM indices favored mortality prediction over SIPA, with an OR of 0.19 (95% CI, 0.08-0.42; P < 0.001). Regarding secondary outcomes, both indices were associated with increased blood product transfusion risk (OR 0.28; 95% CI, 0.18-0.42; P < 0.001), but no significant difference was found between SIPA and rSIG/rSIM for this outcome (P = 0.149).

A primary limitation noted by the authors is the substantial heterogeneity in the SIPA metric (I2=99.0%). While SIPA remains an informative tool for identifying transfusion and resource-use needs, the rSIG/rSIM indices demonstrated a more consistent association with mortality. These findings suggest rSIG/rSIM may be a more robust tool for early mortality risk stratification when the Glasgow Coma Scale is reliably measured.

How this fits prior evidence

This meta-analysis addresses a gap in identifying reliable mortality risk stratification tools for pediatric trauma. While previous evidence noted that prehospital whole blood transfusion did not show a statistically significant mortality benefit over component therapy, this study focuses on the predictive accuracy of specific clinical indices. The findings suggest that rSIG/rSIM may provide a more consistent association with mortality than SIPA, though both indices are associated with increased transfusion risk.

Researchers analyzed data from over 350,000 pediatric trauma patients to compare two different ways of measuring risk. They looked at the SIPA index and the rSIG index, which includes the Glasgow Coma Scale. The goal was to see which method better predicted mortality in children who suffered serious injuries.

The results showed that the rSIG index had a stronger and more consistent link to mortality than the SIPA index. While both methods were able to identify patients who might need blood product transfusions, the rSIG method was more reliable for identifying high-risk patients early on. This is especially useful when the Glasgow Coma Scale can be measured accurately.

Because this was an observational study, the results show a link rather than a direct cause. Additionally, the SIPA index still provides useful information regarding blood transfusions and resource use. These findings suggest that the rSIG index may be a more consistent tool for doctors to use when trying to quickly identify which children are at the highest risk of death after a trauma.

What this means for you:

The rSIG index shows a more consistent link to mortality in pediatric trauma than the SIPA index.

Common questions

What is the difference between SIPA and rSIG for pediatric patients?

Both SIPA and rSIG are used to assess risk in children with trauma. While both methods can identify patients who need blood transfusions, the rSIG index showed a stronger and more consistent association with mortality. This makes rSIG a potentially more reliable tool for early risk assessment when the Glasgow Coma Scale is available.

Is the rSIG index better for predicting blood transfusions?

The study found that both the SIPA and rSIG indices were effective at identifying patients who might need blood product transfusions. There was no significant difference between the two methods specifically for predicting transfusion needs, meaning both remain useful for that specific purpose.

How large was the study and who was involved?

The analysis included a very large sample size of 352,871 pediatric trauma patients under the age of 18. This large amount of data helped researchers compare the two different scoring systems to see which one performed better in identifying mortality risks.

Study Details

Study typeMeta analysis

EvidenceLevel 1

Follow-up216.0 mo

PublishedOct 2026

PMID42848028

View Original Abstract ↓

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

rSIG and rSIM indices show stronger association with mortality than SIPA in pediatric traumaNew Tool Shows Better Way to Predict Pediatric Trauma Mortality

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