Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study

Abstract

Hemorrhage, a main cause of mortality in patients with trauma, affects vital signs such as blood pressure and heart rate. Shock index (SI), calculated as heart rate divided by systolic blood pressure, is widely used to estimate the shock status of patients with hemorrhage. The difference in SI between the emergency department and prehospital field can indirectly reflect urgency after trauma. We aimed to determine the association between delta SI (DSI) and in-hospital mortality in patients with torso or extremity trauma. Patients with DSI >0.1 are expected to be associated with high mortality. This retrospective, observational study used data from the Pan-Asian Trauma Outcomes Study. Patients aged 18–85 years with abdomen, chest, upper extremity, lower extremity, or external injury location were included. Patients from China, Indonesia, Japan, Philippines, Thailand, and Vietnam; those who were transferred from another facility; those who were transferred without the use of emergency medical service; those with prehospital cardiac arrest; those with unknown exposure and outcomes were excluded. The exposure and primary outcome were DSI and in-hospital mortality, respectively. The secondary and tertiary outcome was intensive care unit (ICU) admission and massive transfusion, respectively. Multivariate logistic regression analysis was performed to test the association between DSI and outcome. In total, 21,534 patients were enrolled according to the inclusion and exclusion criteria. There were 3,033 patients with DSI >0.1. The in-hospital mortality rate in the DSI >0.1 and ≤0.1 groups was 2.0% and 0.8%, respectively. In multivariate logistic regression analysis, the DSI ≤0.1 group was considered the reference group. The unadjusted and adjusted odds ratios of in-hospital mortality in the DSI >0.1 group were 2.54 (95% confidence interval [CI] 1.88–3.42) and 2.82 (95% CI 2.08–3.84), respectively. The urgency of traumatic hemorrhage can be determined using DSI, which can help hospital staff to provide proper trauma management, such as early trauma surgery or embolization.

Prehospital Shock Index Multiplied by Avpu Scale as a Predictor of Clinical Outcomes in Traumatic Injury

“…Schellenberg et al ( 29) included 1,294 patients with trauma and showed that the ED delta SI was strongly predictive of mortality, need for blood product transfusion, and ICU length of stay. Kim et al (30) reported similar results regarding the association between delta SI and inhospital mortality in patients with torso or extremity traumas. However, the prehospital transport time in Taiwan is generally less than 20 min.…”

Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis

“…Two studies involved the geriatric population [ 33 , 35 ], while Montoya et al [ 36 ] considered only patients younger than 50 years old. Seven studies excluded patients with traumatic brain injuries (TBI) [ 17 , 21 , 32 , 33 , 35 , 37 , 41 ]. Some variability was observed regarding the definition of MT and mortality.…”

“…Some variability was observed regarding the definition of MT and mortality. Almost all studies defined MT as 10 red blood cells (RBC units within 24 h [ 19 , 21 , 22 , 28 , 38 , 40 , 42 , 44 , 47 , 51 , 52 ] and mortality as in-hospital mortality [ 18 , 22 , 25 – 29 , 31 , 33 – 35 , 38 , 41 ]. Different definitions are a further source of potential heterogeneity.…”

“…To reduce the potential source of heterogeneity due to different timepoint for mortality definition, we performed a subgroup analysis considering 12 studies reporting hospital mortality [ 18 , 26 – 29 , 31 , 33 – 35 , 38 , 41 , 42 ], as this was the most frequently reported timepoint for mortality assessment. For an optimal cut-off of 0.795, SI showed a sensitivity of 0.325 [0.161; 0.547] and a specificity of 0.736 [0.600; 0.838] to predict hospital mortality.…”

Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow Coma Scale predicting clinical outcomes in traumatic brain injury: Evidence from a 10-year analysis in a single center

“…Therefore, a single data point of vital signs and GCS in a progressive injury may not always reflect the clinical condition. Many studies have been suggested using a series of follow-up scoring systems to improve prediction accuracy, such as delta SI ( 31 , 32 ). Series rSIG measurement not only reflects the disease progression but also decreases the impairment of measure time variation.…”