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.