The predictive value of pH-corrected calcium concentration combined with rSIG index for coagulation dysfunction in children with multiple traumas

Wang Xiuqin; Xu Weihua

doi:10.3969/j.issn.1002-1949.2026.03.008

Abstract：Objective To evaluate the predictive value of pH-corrected calcium concentration combined with rSIG index for coagulation dysfunction in children with multiple trauma.Methods Clinical data of 164 pediatric patients with multiple trauma admitted to the emergency department of our hospital from July 2020 to November 2025 were retrospectively collected.According to whether coagulation dysfunction occurred within 24 hours of admission,they were divided into coagulation dysfunction group(n=39)and non-coagulation dysfunction group(n=125).pH-corrected calcium concentration and rSIG index were calculated.Multivariate Logistic regression was used to analyze the independent influencing factors of coagulation dysfunction.The predictive value of pH-corrected calcium,rSIG alone and combined application was evaluated by receiver operating characteristic(ROC)curve.The difference of area under curve(AUC)was compared by Delong test.Spearman correlation analysis was used to evaluate the correlation between pH-corrected calcium,rSIG and coagulation indexes.Results The coagulation dysfunction group had significantly lower platelet count(PLT),fibrinogen,arterial pH,pH-corrected calcium,and rSIG index,and higher injury severity score(ISS)and lactate levels(P<0.05).Multivariate Logistic regression results showed that after adjusting for confounding factors such as coagulation indicators,the higher the ISS score[odds ratio(OR)=1.156],the lower the pH-corrected calcium(OR=0.683),and the lower the rSIG index(OR=0.714),the greater the risk of coagulation dysfunction in children with multiple trauma(P<0.05).The AUC of pH-corrected calcium and rSIG index in predicting coagulation dysfunction was 0.865(95%CI 0.798-0.932)and 0.808(95%0.715-0.900).The combination of the two had the highest predictive efficacy,and the AUC reached 0.919(95%CI 0.866-0.971),which was significantly higher than any single index.The results of Delong test showed that Z=3.117,3.256(P<0.05).The sensitivity of combined prediction was 90.4%,and the specificity was 85.6%.The level of pH-corrected calcium was negatively correlated with prothrombin time(PT)and activated partial thromboplastin time(APTT)(P<0.05),and positively correlated with fibrinogen and PLT(P<0.001).The rSIG index was negatively correlated with PT and APTT(P<0.05),and positively correlated with fibrinogen and PLT(P<0.001).Conclusions The combination of pH-corrected calcium and rSIG index demonstrates good predictive value for coagulation dysfunction in pediatric patients with multiple trauma.