Optimal Prospective Predictors of Mortality in Austere Environments

Lammers, Daniel; Conner, Jeffrey R; Marenco, Chris; Morte, Kaitlin; Martin, Matthew J.; Eckert, Matthew J.; Bingham, Jason

doi:10.1016/j.jss.2020.05.040

Cited by 11 publications

(15 citation statements)

References 23 publications

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“…In older patients (aged ≥ 65 years), rSIG also had better predictive accuracy for mortality (AUROC, 0.694) compared to SI, MSI, and ASI (AUROC: 0.502 vs. 0.519 vs. 0.524). These findings also support a study by Lammers et al ( 24 ) of 22,218 adult trauma patients (18 to 65-years-old) from Department of Defense Trauma Registry that showed rSIG had an AUROC as high as that of TRISS in the young population (rSIG AUROC: 0.923 vs. TRISS AUROC: 0.955).…”

Section: Discussionsupporting

confidence: 89%

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

et al. 2022

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ObjectivesEarly identification of traumatic brain injury (TBI) patients at a high risk of mortality is very important. This study aimed to compare the predictive accuracy of four scoring systems in TBI, including shock index (SI), modified shock index (MSI), age-adjusted shock index (ASI), and reverse shock index multiplied by the Glasgow Coma Scale (rSIG).Patients and methodsThis is a retrospective analysis of a registry from the Taipei Tzu Chi trauma database. Totally, 1,791 patients with TBI were included. We investigated the accuracy of four major shock indices for TBI mortality. In the subgroup analysis, we also analyzed the effects of age, injury mechanism, underlying diseases, TBI severity, and injury severity.ResultsThe predictive accuracy of rSIG was significantly higher than those of SI, MSI, and ASI in all the patients [area under the receiver operating characteristic curve (AUROC), 0.710 vs. 0.495 vs. 0.527 vs. 0.598], especially in the moderate/severe TBI (AUROC, 0.625 vs. 0.450 vs. 0.476 vs. 0.529) and isolated head injury populations (AUROC 0.689 vs. 0.472 vs. 0.504 vs. 0.587). In the subgroup analysis, the prediction accuracy of mortality of rSIG was better in TBI with major trauma [Injury Severity Score (ISS) ≥ 16], motor vehicle collisions, fall injury, and healthy and cardiovascular disease population. rSIG also had a better prediction effect, as compared to SI, MSI, and ASI, both in the non-geriatric (age < 65 years) and geriatric (age ≥ 65 years).ConclusionrSIG had a better prediction accuracy for mortality in the overall TBI population than SI, MSI, and ASI. Although rSIG have better accuracy than other indices (ROC values indicate poor to moderate accuracy), the further clinical studies are necessary to validate our results.

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Section: Discussionsupporting

confidence: 89%

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

et al. 2022

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“…17 This newly derived prognostic tool, which consists of the inverse or reverse shock index multiplied by GCS (rSIG), has further demonstrated promise within adult civilian and military trauma populations. [18][19][20][21] Despite this, it has yet to be studied in civilian pediatric populations. This study sought to investigate the utility of using rSIG values as a prospective mortality predictor for civilian pediatric trauma.…”

mentioning

confidence: 99%

Addition of neurological status to pediatric adjusted shock index to predict early mortality in trauma: A pediatric Trauma Quality Improvement Program analysis

Lammers

Marenco

Morte

et al. 2021

J Trauma Acute Care Surg

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Pediatric adjusted shock index (SIPA) has demonstrated the ability to prospectively identify children at the highest risk for early mortality. The addition of neurological status to shock index has shown promise as a reliable triage tool in adult trauma populations. This study sought to assess the utility of combining SIPA with Glasgow Coma Scale (GCS) for predicting early trauma-related outcomes. METHODS:Retrospective review of the 2017 Trauma Quality Improvement Program Database was performed for all severely injured patients younger than 18 years old. Pediatric adjusted shock index and reverse SIPA Â GCS (rSIG) were calculated. Age-specific cutoff values were derived for reverse shock index multiplied by GCS (rSIG) and compared with their SIPA counterparts for early mortality assessment using area under the receiver operating characteristic curve analyses. RESULTS:A total of 10,389 pediatric patients with an average age of 11.4 years, 67% male, average Injury Severity Score of 24.1, and 4% sustaining a major penetrating injury were included in the analysis. The overall mortality was 9.3%. Furthermore, 32.1% of patients displayed an elevated SIPA score, while only 27.5% displayed a positive rSIG. On area under the receiver operating characteristic curve analysis, rSIG was found to be superior to SIPA as a predictor for in hospital mortality with values of 0.854 versus 0.628, respectively. CONCLUSION:Reverse shock index multiplied by GCS more readily predicted in hospital mortality for pediatric trauma patients when compared with SIPA. These findings suggest that neurological status should be an important factor during initial patient assessment. Further study to assess the applicability of rSIG for expanded trauma-related outcomes in pediatric trauma is necessary.

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“…However, an abnormal rSIG was found to be associated with a variety of other outcomes, indicating that it may be a more generalizable and discernable scoring tool. Prior studies have shown rSIG to be superior to SIPA at predicting mortality 10,11 . The current study is the first to use single-institution data to validate rSIG's ability to identify those at risk for early trauma interventions such as ICP monitor/drain, blood transfusion, intubation, and ICU admission, which were the outcomes used to determine optimal early outcomes cutoffs 9 .…”

Section: Discussionmentioning

confidence: 89%

“…The superiority of rSIG to SIPA and its easy calculability make it an appealing tool for EMS in the field, where limited diagnostic resources are available. Prior studies evaluating rSIG have only used large-scale pediatric trauma databases with parameters after arrival to the emergency department (ED) and not single-institution data 9–11 . Validation of rSIG in the field or with institution-specific findings has not yet been reported.…”

mentioning

confidence: 99%

Use of prehospital reverse shock index times Glasgow Coma Scale to identify children who require the most immediate trauma care

Reppucci

Cooper

Nolan

et al. 2023

J Trauma Acute Care Surg

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BACKGROUND:Appropriate prehospital trauma triage ensures transport of children to facilities that provide specialized trauma care. There are currently no objective and generalizable scoring tool for emergency medical services to facilitate such decisions. An abnormal reverse shock index times Glasgow Coma Scale (rSIG), which is calculated using readily available parameters, has been shown to be associated with severely injured children. This study sought to determine if rSIG could be used in the prehospital setting to identify injured children who require the highest levels of care. METHODS:Patients (1-18 years old) transferred from the scene to a level 1 pediatric trauma center from 2010 to 2020 with complete prehospital and emergency department vital signs, and Glasgow Coma Scale (GCS) scores were included. Reverse shock index times GCS was calculated as previously described ((systolic blood pressure/heart rate) Â GCS), and the following cutoffs were used: ≤13.1, ≤16.5, and ≤20.1 for 1-to 6-, 7-to 12-, and 13-to 18-year-old patients, respectively. Trauma activation level and clinical outcomes upon arrival to the pediatric trauma center were collected. RESULTS:There were 247 patients included in the analysis; 66.0% ( 163) had an abnormal prehospital rSIG. Patients with an abnormal rSIG had a higher rate of highest-level trauma activation compared with those with a normal rSIG (38.7% vs. 20.2%, p = 0.013). Patients with an abnormal prehospital rSIG also had higher rates of intubation (28.8% vs. 9.52%, p < 0.001), intracranial pressure monitor (9.20 vs. 1.19%, p = 0.032), need for blood (19.6% vs. 8.33%, p = 0.034), laparotomy (7.98% vs. 1.19%, p = 0.039), and intensive care unit admission (54.6% vs. 40.5%, p = 0.049). CONCLUSION:Reverse shock index times GCS may assist emergency medical service providers in early identification and triage of severely injured children. An abnormal rSIG in the emergency department is associated with higher rates of intubation, need for blood transfusion, intracranial pressure monitoring, laparotomy, and intensive care unit admission. Use of this metric may help to speed the identification, care, and treatment of any injured child.

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Optimal Prospective Predictors of Mortality in Austere Environments

Cited by 11 publications

References 23 publications

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

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

Addition of neurological status to pediatric adjusted shock index to predict early mortality in trauma: A pediatric Trauma Quality Improvement Program analysis

Use of prehospital reverse shock index times Glasgow Coma Scale to identify children who require the most immediate trauma care

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