The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data

Abstract

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury

“…The ISS, AIS, ward, and intensive care unit (ICU) stay were not normally distributed and were, therefore, displayed by median (IQR). The median (IQR) of ISS and AIS was significantly higher in the mortality group than in the survival group (25 11,17-28 and 16 [16][17][18][19][20][21][22][23][24][25] vs 18 [16][17][18][19][20][21][22][23][24][25] and 16 [9][10][11][12][13][14][15][16] , respectively). Traffic accident (45.3%) was the most common injury mechanism, with motorcycle accidents accounting for 34.7% despite wearing helmets according to the Taiwan traffic regulations.…”

“…The rSIG uses easily obtainable physiological variables (SBP, HR, and GCS) and is simple to calculate. A study conducted by SC Wu et al showed the best rSIG cutoff point was 14.8 for trauma patients with head injury, with 86.8% sensitivity and 70.7% specificity 23 . Similarly, our study found that rSIG is a useful tool to predict mortality in adult severe trauma patients with head injury.…”

“…The vital signs and laboratory data were obtained immediately upon arrival at the ED. All of the patients were sent to the ED via an ambulance, and the median time (IQR) from response to transport to ED was about 24 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) minutes. According to Chien CY et al, the median emergency medical service (EMS) response time to suspect trauma OHCA call in Taiwan Taoyuan district was 6.0 (4.0-8.0); Duration to scene time was 10.0 (8.0-14.0); and transport time from the scene to ED was 6.0 (3.0-9.0) 28 "do-not-rescue", 438 patients were eventually included (Fig.…”

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…The maximum possible score on the GCS is 15 and the minimal possible -3, the lower the score the more severe the consciousness disorders. The final scores can be divided into three categories of disorders of consciousness: severe (GCS 3-8), moderate (GCS 9-12) and mild (GCS 13-15) [15].…”

Impact of Adapting the Abbreviated Injury Scale (AIS)-2005 from AIS-1998 on Injury Severity Scores and Clinical Outcome

“…AIS is the fundamental basis of several severity scoring systems, such as the Injury Severity Score (ISS) [2], the Maximum Abbreviated Injury Score [3], the New Injury Severity Score (NISS) [4,5], and the Exponential Injury Severity Score [5]. The most commonly used prediction model for survival probability of trauma patients, the Trauma and Injury Severity Score (TRISS) [6][7][8], is also calculated based on the ISS.…”