The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma

El‐Menyar, Ayman; Goyal, Pankaj; Tilley, Elizabeth; Latifi, Rifat

doi:10.1016/j.jss.2018.02.013

Cited by 66 publications

(58 citation statements)

References 34 publications

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“…In pelvic trauma, the hemodynamic instability on-admission predicts the requirement of massive blood transfusion, injury severity, associated injuries, fracture stability, in-hospital complications, and mortality [21,25,[28][29][30]. However, A higher proportion of our patients was hemodynamically stable, admitted to regular trauma wards, and managed conservatively with lower rates of complications and mortality similar to data from the US and Europe.…”

Section: Discussionsupporting

confidence: 73%

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Abdelrahman

El‐Menyar

Keil

et al. 2020

Preprint

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Background: Traumatic pelvic fracture (TPF) is a significant injury results from high energy impact and has a high morbidity and mortality. Purpose: We aimed to describe the epidemiology, incidence, patterns, management, and outcomes of TPF in multinational level 1 trauma centers. Methods: We conducted a retrospective analysis of all patients with TPF between 2010 and 2016 at two trauma centers in Qatar and Germany. Results: A total of 2112 patients presented with traumatic pelvic injuries, of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41±21 years. In unstable pelvic fracture, the frequent mechanism of injury was motor vehicle crash (41%) followed by falls (35%) and pedestrian hit by vehicle (24%). Apart from both extremities, chest (37.3%) was the most commonly associated injured region. The mean injury severity score (ISS) of 16.5±13.3. Hemodynamic instability was observed in 44%. Blood transfusion was needed in one third while massive transfusion and intensive care admission were required in a tenth and a quarter of cases, respectively. Tile classification was possible in 1228 patients (type A in 60%, B in 30%, and C in 10%). Patients with type C fractures had higher rates of associated injuries, higher ISS , greater pelvis abbreviated injury score (AIS), massive transfusion protocol activation, prolonged hospital stay, complications, and mortality (p-value <0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stays were 15 and 5 days, respectively. The overall mortality rate was 4.7% (86 patients). Conclusion: TPF is a common injury among polytrauma patients. It needs a careful, systematic management approach to address the associated complexities and the polytrauma nature.

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Section: Discussionsupporting

confidence: 73%

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Abdelrahman

El‐Menyar

Keil

et al. 2020

Preprint

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“…The model established by combining age, sex, pre-hospital SI, admission HR, Hb and SpO2 can better predict blood transfusion 3 hours before admission [22]. The post-traumatic SI is important in assessing the need for blood transfusion and can predict the demand for massive blood transfusion, laparotomy and mortality [23]. The shock index is more sensitive than the ABC score in predicting traumatic massive blood transfusion [24].…”

Section: Discussionmentioning

confidence: 99%

Intelligent prediction of RBC demand in trauma patients using decision tree methods

Feng

Liu

et al. 2020

Preprint

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Background: The vital signs of trauma patients are complex and changeable, and the prediction of blood transfusion demand mainly depends on doctors' experience and trauma scoring system; therefore, it cannot be accurately predicted. In this study, a machine learning decision tree algorithm (classification and regression tree, CRT and eXtreme gradient boosting, XGBoost) was proposed for the demand prediction of traumatic blood transfusion to provide technical support for doctors. Methods: A total of 1,371 trauma patients who were diverted to the emergency department from January 2014 to January 2018 were collected from an emergency trauma database. The vital signs, laboratory examination parameters and blood transfusion volume were used as variables, and the non-invasive parameters and all (non-invasive + invasive) parameters were used to construct an intelligent prediction model for RBC demand by logistic regression (LR), CRT and XGBoost. The prediction accuracy of the model was compared with the area under the curve (AUC).Results: The studies we performed showed that non-invasive parameters were used to predict blood transfusion. The LR method was the best, with an AUC of 0.72 (95% confidence interval [CI] 0.657-0.775), which was higher than the CRT AUC of 0.69 (95% CI 0.633-0.751) and the XGBoost AUC of 0.71 (95% CI 0.654-0.756) (P<0.05). The trauma site and shock index are important prediction parameters. For all the prediction parameters, XGBoost was the best, with an AUC of 0.94 (95% CI 0.893-0.981), which was higher than the LR AUC of 0.80 (95% CI 0.744-0.850) and the CRT AUC of 0.82 (95% CI 0.779-0.853) (P<0.05). Haematocrit/Haemoglobin is an important prediction parameter. Conclusions: The classification performance of the intelligent prediction model constructed by the decision tree algorithm is not inferior to that of the traditional LR method. With the increase in the data quantity, the accuracy of the model improved in the iteration process, and the prediction performance continuously improved, which is conducive to clinical application and wide promotion.

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“…An earlier study demonstrated a higher mortality rate in trauma patients with hemodynamic instability. The reported mortality rates vary quite widely which could be as high as 30% [22][23][24][25]. In this cohort the overall mortality was low 4.7%, but correlates well with reported cases from previous studies in Germany (4%) and united states (3.5%); this may reflect the maturation of our trauma system and improved post-traumatic care with availability of specialized team, MTP activation, immediate access to operative room and interventional radiology as well as subsequent critical care [18,[26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Abdelrahman

El‐Menyar

Keil

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Purpose we aimed to describe traumatic pelvic fracture in multinational level 1 trauma centers. Methods We conducted a retrospective analysis for all patients with traumatic pelvic fracture (TPF) between 2010 and 2016 at 2 trauma centers in Qatar and Germany. Results A total of 2112 patients presented with traumatic pelvic injuries of which 1814 (85.9%) sustained TPF, males dominated (76.5%) with a mean age of 41.2±21.1 years. Falls, motor vehicle crashes and pedestrians were the most frequent mechanisms involved. Chest (37.3%) was the most commonly associated injured region, with mean injury severity score (ISS) of 16.5±13.3. Hemodynamic instability was observed in 44%, blood was needed in a third, massive transfusion in a tenth and intensive care admission in a quarter of cases. Tile classification was possible in 1228 patients (type A in 60%, B in 30% and C in 10%). Patients with type C had higher rates of associated injuries, ISS, pelvis abbreviated injury score (AIS), more need for blood transfusion, massive transfusion protocol activation, prolonged hospital stay, higher rate for surgery, complications, and mortality (p<0.001). Two-thirds of patients were managed conservatively while a third needed surgical fixation. The median length of hospital and intensive care stay were 15 and 5 days, respectively. In-hospital complications were few and the overall mortality rate was 4.7% (86 patients). Conclusion pelvic fracture is a common injury. It needs a careful multidisciplinary and systematic approach to address the associated complexities and polytrauma nature in order to improve the associated outcomes both on a short and long-term basis.

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The clinical utility of shock index to predict the need for blood transfusion and outcomes in trauma

Cited by 66 publications

References 34 publications

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

Intelligent prediction of RBC demand in trauma patients using decision tree methods

Patterns, Management and Outcomes of Traumatic Pelvic Fracture: Insights from A Multicenter Study

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