Shock index predicts mortality in geriatric trauma patients

Pandit, Viraj; Rhee, Peter; Hashmi, Ammar; Kulvatunyou, Narong; Tang, Andrew; Khalil, Mazhar; OʼKeeffe, Terence; Green, Donald P.; Friese, Randall S.; Joseph, Bellal

doi:10.1097/ta.0000000000000160

Cited by 112 publications

(80 citation statements)

References 18 publications

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“…In its evolution, an SI > 0.9 was proposed as an indicator of impending hemorrhagic shock (58,60,61). Indeed, there is compelling evidence suggesting that SI is more sensitive than either HR or SBP alone as an early predictor of hemorrhage (60,62,63), massive transfusion (64), morbidity (58), and mortality in geriatric patients (59,61). Based on the SI threshold of 0.9, doctrine would indicate that Group 2 would be considered at higher risk for developing shock than Group 1.…”

Section: A Model With a Reproducible Clinical Outcomementioning

confidence: 99%

The Compensatory Reserve For Early and Accurate Prediction Of Hemodynamic Compromise

Convertino

Wirt

Glenn

et al. 2016

Shock

100

188

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Shock is deadly and unpredictable if it is not recognized and treated in early stages of hemorrhage. Unfortunately, measurements of standard vital signs that are displayed on current medical monitors fail to provide accurate or early indicators of shock because of physiological mechanisms that effectively compensate for blood loss. As a result of new insights provided by the latest research on the physiology of shock using human experimental models of controlled hemorrhage, it is now recognized that measurement of the body's reserve to compensate for reduced circulating blood volume is the single most important indicator for early and accurate assessment of shock. We have called this function the "compensatory reserve," which can be accurately assessed by real-time measurements of changes in the features of the arterial waveform. In this paper, the physiology underlying the development and evaluation of a new noninvasive technology that allows for real-time measurement of the compensatory reserve will be reviewed, with its clinical implications for earlier and more accurate prediction of shock.

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Section: A Model With a Reproducible Clinical Outcomementioning

confidence: 99%

The Compensatory Reserve For Early and Accurate Prediction Of Hemodynamic Compromise

Convertino

Wirt

Glenn

et al. 2016

Shock

100

188

View full text Add to dashboard Cite

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“…The shock index (SI), calculated as heart rate (HR) divided by systolic blood pressure (SBP), is a measure of hemodynamic stability that is useful in predicting mortality and injury severity in trauma patients (89101112). The SI is superior to heart rate and systolic blood pressure alone in predicting mortality in geriatric trauma patients (1314). …”

Section: Introductionmentioning

confidence: 99%

“…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). In the present study, we assessed the predictive power of the SI, MSI, and Age SI in geriatric patients using a single large nationwide trauma database.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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The shock index (SI), modified shock index (MSI), and age multiplied by SI (Age SI) are used to assess the severity and predict the mortality of trauma patients, but their validity for geriatric patients is controversial. The purpose of this investigation was to assess predictive value of the SI, MSI, and Age SI for geriatric trauma patients. We used the Emergency Department-based Injury In-depth Surveillance (EDIIS), which has data from 20 EDs across Korea. Patients older than 65 years who had traumatic injuries from January 2008 to December 2013 were enrolled. We compared in-hospital and ED mortality of groups categorized as stable and unstable according to indexes. We also assessed their predictive power of each index by calculating the area under the each receiver operating characteristic (AUROC) curve. A total of 45,880 cases were included. The percentage of cases classified as unstable was greater among non-survivors than survivors for the SI (36.6% vs. 1.8%, P < 0.001), the MSI (38.6% vs. 2.2%, P < 0.001), and the Age SI (69.4% vs. 21.3%, P < 0.001). Non-survivors had higher median values than survivors on the SI (0.84 vs. 0.57, P < 0.001), MSI (0.79 vs. 1.14, P < 0.001), and Age SI (64.0 vs. 41.5, P < 0.001). The predictive power of the Age SI for in-hospital mortality was higher than SI (AUROC: 0.740 vs. 0.674, P < 0.001) or MSI (0.682, P < 0.001) in geriatric trauma patients.

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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 predicts mortality in geriatric trauma patients

Abstract: Prognostic/epidemiologic study, level III.

Cited by 112 publications

References 18 publications

The Compensatory Reserve For Early and Accurate Prediction Of Hemodynamic Compromise

The Compensatory Reserve For Early and Accurate Prediction Of Hemodynamic Compromise

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

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

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