Correlation of shock index and modified shock index with the outcome of adult trauma patients: A prospective study of 9860 patients

Abstract

Background:Triage at emergency department is performed to identify those patients who are relatively more serious and require immediate attention and treatment. Despite current methods of triage, trauma continues to be a leading cause of morbidity and mortality.Aims:This study was to evaluate the predictive value of shock index (SI) and modified shock index (MSI) for hospital mortality among adult trauma patients.Materials and Methods:In this prospective longitudinal study, all adult patients who sustained trauma enrolled as per as inclusion/exclusion criteria. After the collection of data, SI and MSI were calculated accordingly. All parameters were again recorded hourly and calculations were done at six-hour intervals. Further, to achieve a value that can be analyzed, we determined threshold value for vital signs, which set the threshold values as heart rate at 120 beats per minute, systolic blood pressure at less than 90, and SI at cut-off 0.5-0.9 and MSI at less than 0.7 to more than 1.3.Results:We analyzed 9860 adult trauma patients. Multivariate regression analysis demonstrated that heart rate more than 120 beats per minute, systolic blood pressure less than 90 mmHg, and diastolic blood pressure (DBP) less than 60 mmHg correlate with hospital stay and mortality rate. MSI <0.7 and >1.3 had higher odds of mortality as compared to other predictors.Conclusions:MSI is an important marker for predicting the mortality rate and is significantly better than heart rate, systolic blood pressure, DBP and SI alone. Therefore, modified SI should be used in the triage of serious patients, including trauma patients in the emergency room.

Validation of the Shock Index, Modified Shock Index, and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments

“…For each indicator, we defined the different cut-off values of hemodynamic instability according to previous research (131517). Hemodynamic instability was defined as an SI equal to or greater than 1, an MSI equal to or greater than 1.3, and an Age SI equal to or greater than 50.…”

“…Previous research suggested that SI multiplied by age (Age SI) is a better predictor of mortality following traumatic injury of an elderly patient (15). Another investigator proposed use of the modified shock index (MSI), the ratio of heart rate to mean blood pressure, as a more accurate predictor than systolic blood pressure, heart rate, and SI (1617). However SI, MSI, and Age SI were developed and validated for different populations (111213).…”

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

“…Moreover, the SI and MSI after PCI and treatment were not evaluated. Singh et al [15] pointed out that MSI of 0.7 or greater also predicts poor outcome in patients with trauma. This study only divided the patients into 2 groups by a cut point of MSI of 1.4 as the MSI less than 0.7 was only seen in 2 cases without 7-day MACE.…”

“…Some studies have found that MSI is a better predictor than SI for the outcome in adult patients with trauma [14,15]. However, the predictive value of MSI has not been evaluated in the patients with STEMI.…”

Shock Index as a Predictor of Myocardial Damage and Clinical Outcome in ST-Elevation Myocardial Infarction

“…35 However, to the best of our knowledge, only one small (n=160), retrospective study compared the shock index with the modified shock index for the short-term prediction of a combined clinical endpoint (all-cause mortality, life-threatening arrhythmias, cardiogenic shock, and heart failure) in patients after STEMI. 36 The authors of this study found that both the shock index and the modified shock index were independent predictors of MACE, but the odds ratio of the modified shock index was numerically higher than that of the shock index.…”