Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma

Asim, Mohammad; El‐Menyar, Ayman; Chughtai, Talat; Al-Hassani, Ammar; Abdelrahman, Husham; Rizoli, Sandro; Al-Thani, Hassan

doi:10.1016/j.jss.2022.10.067

Cited by 4 publications

(3 citation statements)

References 38 publications

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“…Twenty-six studies have been considered for secondary outcome [ 6 , 17 – 20 , 23 , 24 , 26 – 43 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

Antolini

Casarotta

Gasparri³

et al. 2023

Crit Care

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Background Management of bleeding trauma patients is still a difficult challenge. Massive transfusion (MT) requires resources to ensure the safety and timely delivery of blood products. Early prediction of MT need may be useful to shorten the time process of blood product preparation. The primary aim of this study was to assess the accuracy of shock index to predict the need for MT in adult patients with trauma. For the same population, we also assessed the accuracy of SI to predict mortality. Methods This systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. We performed a systematic search on MEDLINE, Scopus, and Web of Science from inception to March 2022. Studies were included if they reported MT or mortality with SI recorded at arrival in the field or the emergency department. The risk of bias was assessed using the QUADAS-2. Results Thirty-five studies were included in the systematic review and meta-analysis, for a total of 670,728 patients. For MT the overall sensibility was 0.68 [0.57; 0.76], the overall specificity was 0.84 [0.79; 0.88] and the AUC was 0.85 [0.81; 0.88]. Positive and Negative Likelihood Ratio (LR+; LR−) were 4.24 [3.18–5.65] and 0.39 [0.29–0.52], respectively. For mortality the overall sensibility was 0.358 [0.238; 0.498] the overall specificity 0.742 [0.656; 0.813] and the AUC 0.553 (confidence region for sensitivity given specificity: [0.4014; 0.6759]; confidence region for specificity given sensitivity: [0.4799; 0.6332]). LR+ and LR− were 1.39 [1.36–1.42] and 0.87 [0.85–0.89], respectively. Conclusions Our study demonstrated that SI may have a limited role as the sole tool to predict the need for MT in adult trauma patients. SI is not accurate to predict mortality but may have a role to identify patients with a low risk of mortality.

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“…Twenty-six studies have been considered for secondary outcome [ 6 , 17 – 20 , 23 , 24 , 26 – 43 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Antolini

Casarotta

Gasparri³

et al. 2023

Crit Care

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“…Wang & Peng, 2024). Delayed enormous hemothorax after blunt thoracic trauma is uncommon, but it is nevertheless linked to high rates of morbidity and mortality (Asim et al, 2023;Gilaed et al, 2024;Lin et al, 2024).…”

Section: Introductionmentioning

confidence: 99%

Delayed Hemothorax Due to Thoracic Trauma with Multiple Rib Fracture: A Case Report

Wibowo,

Palupi,

Triyono

2024

JHS

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Recent evidence indicates that elderly who have suffered rib fractures may develop delayed massive hemothorax. Delayed enormous hemothorax after thoracic trauma is uncommon, but it is nevertheless linked to high rates of mortality. This single case report provides an overview of the ordinary and important delayed hemothorax caused by thoracic trauma with multiple rib fractures in limited healthcare facilities. We observe symptoms and chest X-rays before and after the development of delayed hemothorax. A 56-year-old man came to the hospital with complaints of shortness of breath and pain in the chest and right shoulder. The patient said that four days ago, He fell from a height of around 6 meters. After visiting the hospital four days prior, the patient was diagnosed with multiple fractures of the inferior aspect of the right ribs (costa 3-7) as well as a fracture of the right clavicle. However, the patient declined surgery and was made to return home. At that time, the patient did not experience shortness of breath. Currently, the patient is experiencing dyspnea. Blood pressure 138/91 mmHg, heart rate 89 beats per minute, respiration rate 26 times per minute, Spo2 91% room air. The chest x-ray currently shows a right hemothorax. After stabilization, the patient asked to be referred to another hospital for further treatment. Patients with multiple fractured ribs, especially with rib displacement, are at high risk of evolving delayed hemothorax. Close monitoring and observation for several days are necessary.

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Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

Ahmed,

Moussa,

Ali

et al. 2024

BMC Emerg Med

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Introduction The assessment of hemodynamic status in polytrauma patients is an important principle of the primary survey of trauma patients, and screening for ongoing hemorrhage and assessing the efficacy of resuscitation is vital in avoiding preventable death and significant morbidity in these patients. Invasive procedures may lead to various complications and the IVC ultrasound measurements are increasingly recognized as a potential noninvasive replacement or a source of adjunct information. Aimof this study The study aimed to determine if repeated ultrasound assessment of the inferior vena cava (diameter, collapsibility (IVC- CI) in major trauma patients presenting with collapsible IVC before resuscitation and after the first hour of resuscitation will predict total intravenous fluid requirements at first 24 h. Patients & methods The current study was conducted on 120 patients presented to the emergency department with Major blunt trauma (having significant injury to two or more ISS body regions or an ISS greater than 15). The patients(cases) group (shocked group) (60) patients with signs of shock such as decreased blood pressure < 90/60 mmHg or a more than 30% decrease from the baseline systolic pressure, heart rate > 100 b/m, cold, clammy skin, capillary refill > 2 s and their shock index above0.9. The control group (non-shocked group) (60) patients with normal blood pressure and heart rate, no other signs of shock (normal capillary refill, warm skin), and (shock index ≤ 0.9). Patients were evaluated at time 0 (baseline), 1 h after resucitation, and 24 h after 1st hour for:(blood pressure, pulse, RR, SO2, capillary refill time, MABP, IVCci, IVCmax, IVCmin). Results Among 120 Major blunt trauma patients, 98 males (81.7%) and 22 females (18.3%) were included in this analysis; hypovolemic shocked patients (60 patients) were divided into two main groups according to IVC diameter after the first hour of resuscitation; IVC repleted were 32 patients (53.3%) while 28 patients (46.7%) were IVC non-repleted. In our study population, there were statistically significant differences between repleted and non-repleted IVC cases regarding IVCD, DIVC min, IVCCI (on arrival) (after 1 h) (after 24 h of 1st hour of resuscitation) ( p-value < 0.05) and DIVC Max (on arrival) (after 1 h) (p-value < 0.001). There is no statistically significant difference (p-value = 0.075) between repleted and non-repleted cases regarding DIVC Max (after 24 h).In our study, we found that IVCci0 at a cut-off point > 38.5 has a sensitivity of 80.0% and Specificity of 85.71% with AUC 0.971 and a good 95% CI (0.938 – 1.0), which means that IVCci of 38.6% or more can indicate fluid responsiveness. We also found that IVCci 1 h (after fluid resuscitation) at cut-off point > 28.6 has a sensitivity of 80.0% and Specificity of 75% with AUC 0.886 and good 95% CI (0.803 – 0.968), which means that IVCci of 28.5% or less can indicate fluid unresponsiveness after 1st hour of resuscitation. We found no statistically significant difference between repleted and non-repleted cases regarding fluid requirement and amount of blood transfusion at 1st hour of resuscitation (p-value = 0.104). Conclusion Repeated bedside ultrasonography of IVCD, and IVCci before and after the first hour of resuscitation could be an excellent reliable invasive tool that can be used in estimating the First 24 h of fluid requirement in Major blunt trauma patients and assessment of fluid status.

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Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma

Cited by 4 publications

References 38 publications

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

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

Delayed Hemothorax Due to Thoracic Trauma with Multiple Rib Fracture: A Case Report

Evaluation of the role of repeated inferior vena cava sonography in estimating first 24 h fluid requirement in resuscitation of major blunt trauma patients in emergency department Suez Canal University Hospital

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