Shock index as a mortality predictor in patients with acute polytrauma

Montoya, Kevin F.; Charry, José D.; Calle‐Toro, Juan S.; Núñez, Luis Ramiro; Poveda, Gustavo

doi:10.1016/j.joad.2015.04.006

Cited by 50 publications

(41 citation statements)

References 20 publications

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“…SI has been previously described as a predictive metric of mortality and morbidity in specific patient populations, at cut-offs (0.7, 0.9) lower than our findings: Montoya et al evaluated more than 1000 patients in a national trauma registry, showing higher mortality in 24 hours for patients with SI>0.97; a study conducted by Reinstadler et al demonstrated that patients with recent myocardial infarction had higher myocardial damage with elevated SI above 0.62 and independently associated with major adverse cardiac events at 12 months12; Wira et al concluded that 38.6% of septic patients presenting to the ED with sustained SI elevation required vasopressors within 72 hours of ED admission, compared with 11.6% of those without a sustained SI elevation (OR 4.42; p<0.0001)23; Rady et al conducted a prospective study of 275 general adult ED patients, and concluded that SI>0.9 could identify acute critical illness and was associated with higher total admissions and intensive care unit admissions 2. These lower thresholds were unable to distinguish those at risk for admission or mortality.…”

Section: Discussioncontrasting

confidence: 57%

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments

et al. 2019

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Study objectivesThe shock index (SI), defined as the ratio of the heart rate (HR) to the systolic blood pressure (BP), is used as a prognostic tool in trauma and in specific disease states. However, there is scarcity of data about the utility of the SI in the general emergency department (ED)population. Our goal was to use a large national database of EDs in the United States (US) to determine whether the likelihood of inpatient mortality and hospital admission was associated with initial SI at presentation.MethodsData from the National Hospital Ambulatory Medical Care Survey were retrospectively reviewed to obtain a weighted sample of all US ED visits between 2005 and 2010. All adults >18 years old who survived the ED visit were included, regardless of their chief complaint. Likelihood ratios (LR) were calculated for a range of SI values, in order to determine SI thresholds most predictive of hospital admission and inpatient mortality. +LRs >5 were considered to be clinically significant.ResultsA total of 526 455 251 adult patient encounters were included in the analysis. 56.9% were women, 73.9% were white and 53.2% were between the ages of 18 and 44 years. 88 326 638 (15.7%) unique ED visits resulted in hospital admission and 1 927 235 (2.6%) visits resulted in inpatient mortality. SI>1.3 was associated with a clinically significant increase in both the likelihood of hospital admission (+LR=6.64) and inpatient mortality (+LR=5.67). SI>0.7 and >0.9, the traditional cited cut-offs, were only associated with marginal increases (+LR= 1.13; 1.54 for SI>0.7 and +LR=1.95; 2.59 for SI>0.9 for hospital admission and inpatient mortality, respectively).ConclusionsIn this largest retrospective study to date on SI in the general ED population, we demonstrated that initial SI at presentation to the ED could potentially be useful in predicting the likelihood of hospital admission and inpatient mortality, which could help guide rapid and accurate acuity designation, resource allocation and disposition.

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Section: Discussioncontrasting

confidence: 57%

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments

et al. 2019

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“…On the other hand, patients with lower SI scores were less likely to develop hypotension but were more likely to develop hypertension and bradycardia. It is well known that a high SI predicts mortality in acute polytrauma patients [30], [31]. A more recent study showed that elevated SI predicts death in all trauma patients, but low SI values predicted death in head injured patients.…”

Section: Ketamine-induced Changes In Blood Pressure and Heart Rate Inmentioning

confidence: 99%

Ketamine-induced Changes in Blood Pressure and Heart Rate in Pre-hospital Intubated Patients

Sheth

Brand²,

Halterman

2017

Adv. J. Grad. Res.

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A B S T R A C TWhen a patient experiences trauma, pre-hospital rapid sequence intubation (RSI) is often the course of action. While RSI is associated with favorable neurological outcomes among traumatic brain injury patients, it also carries the risk of increased hypotension and bradycardia. Ketamine is a fast-acting anesthetic agent used in RSI, attractive due to its ability to raise heart rate (HR) and blood pressure (BP) and thus potentially lessening the severity of RSIrelated hypotension and bradycardia. However, research in support of its use is inconclusive, with different studies reporting increases or decreases in BP and HR after ketamine administration. To study the effect of ketamine on HR and BP during RSI, we analyzed the data obtained from 1,516 patients who received trauma and nontrauma medical care including RSI from first responders and emergency personnel using two different statistical methods. We determined if there was any association between the vital signs prior to administration of ketamine and outcomes such as bradycardia and/or hypotension post-ketamine administration in patients undergoing RSI. We found that the vital signs prior to administration of ketamine (i.e. BP and HR) predict the development of bradycardia and/or hypotension in patients undergoing RSI and the relationship between baseline vital signs and the development of bradycardia and/or hypotension is moderated by the dose of ketamine. Results obtained from this study may help responders and emergency care personnel to identify the patients that are likely to benefit from ketamine as an anesthetic agent.

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“…Shock index (ie, heart rate divided by systolic blood pressure) was used to demonstrate trauma injury severity among study patients; a shock index of ≥0.9 indicated a patient with severe to critical injuries. 13 Injury types were categorized by all burn injuries, penetrating injury, blunt injury, or penetrating and blunt injury. Mechanism of injury was categorized by all explosions, gunshot wound, motor vehicle crash, fall, and other.…”

Section: Injury and Intervention Categoriesmentioning

confidence: 99%

En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan

Staudt

Savell²,

Biever³

et al. 2018

Critical Care Nurse

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Background En route care is the transfer of patients requiring combat casualty care within the US military evacuation system. No reports have been published about en route care of patients during transfer from a forward surgical facility (role 2) to a combat support hospital (role 3) for comprehensive care. Objective To describe patients transferred from a role 2 to a role 3 US military treatment facility in Afghanistan. Methods A retrospective review of data from the Joint Trauma System Role 2 Database was conducted. Patient characteristics were described by en route care medical attendants. Results More than one-fourth of patients were intubated at transfer (26.9%), although at transfer fewer than 10% of patients had a base deficit of more than 5 (3.5%), a pH of less than 7.3 (5.2%), an international normalized ratio of more than 2 (0.8%), or temporary abdominal or chest closure (7.4%). The en route care medical attendant was most often a nurse (35.5%), followed by technicians (14.1%) and physicians (10.0%). Most patients (75.3%) were transported by medical evacuation (on rotary-wing aircraft). Conclusion This is the first comprehensive review of patients transported from a forward surgical facility to a more robust combat support hospital in Afghanistan. Understanding the epidemiology of these patients will inform provider training and the appropriate skill mix for the transfer of postsurgical patients within a combat setting. (Critical Care Nurse. 2018;38[2]:e7-e15)

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Shock index as a mortality predictor in patients with acute polytrauma

Cited by 50 publications

References 20 publications

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments

Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments

Ketamine-induced Changes in Blood Pressure and Heart Rate in Pre-hospital Intubated Patients

En Route Critical Care Transfer From a Role 2 to a Role 3 Medical Treatment Facility in Afghanistan

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