The role of shock index as a predictor of multiple‐trauma patients' pathways

Toccaceli, Andrea; Giampaoletti, Andrea; Dignani, Lucia; Lucertini, Carla; Petrucci, Cristina; Lancia, Loreto

doi:10.1111/nicc.12152

Cited by 9 publications

(6 citation statements)

References 32 publications

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“…As expected, the decreased MAP was accompanied by an increased HR. Alterations in these vital parameters were associated with worse clinical outcomes and with increased mortality of critically injured patients 25,26 . In the present study, the impaired cardiac function after multiple trauma was manifested by a reduced maximal systolic LVP as well as by a decreased LVEDP in both RIA groups.…”

Section: Discussionsupporting

confidence: 53%

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Lackner

Weber

Miclau

et al. 2020

Journal Orthopaedic Research

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Cardiac injuries are recorded after multiple trauma and are associated with a poor patient outcome. Reaming prior to locked intramedullary nailing is a frequently used technique to stabilize femoral diaphysis fractures. However, in polytraumatized patients, complications such as fat emboli and acute respiratory distress syndrome have been associated with reaming. The reaming irrigator aspirator (RIA) system provides concomitant irrigation and suction of the intramedullary contents, and should, therefore, reduce reaming‐associated complications. The aim of the study was to investigate cardiac function after multiple trauma with regard to two different RIA devices (RIAI vs RIAII). 15 male pigs were included in the study. Pigs received either sham treatment or multiple trauma (chest trauma, femur fracture, liver laceration, and hemorrhagic shock), followed by intramedullary nailing after reaming with either the RIAI or RIAII system (RIAII: reduced diameter of the reamer, improved control of irrigation and suction). Cardiac function was assessed by transesophageal echocardiography and systemic inflammation as well as local cardiac damage examined. Pigs of both treatment groups showed impaired cardiac function, valvular insufficiency, and cardiac damage. Systemic inflammation and local cardiac alterations were observed which might contribute to early myocardial damage in vivo. Multiple trauma including long‐bone fracture and subsequent intramedullary reaming induces cardiac dysfunction and valvular insufficiency, which might be linked to both mechanical cardiac injury and increased systemic inflammation. 6 hours after trauma there are less differences between RIAI and RIAII treatment with regard to post‐traumatic cardiac consequences in multiple injured pigs, indicating no beneficial effect of RIAII over RIAI.

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Section: Discussionsupporting

confidence: 53%

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Lackner

Weber

Miclau

et al. 2020

Journal Orthopaedic Research

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“…However, many of these scoring tools are inconvenient for initial use in an emergency department (ED) because the calculations are complex or because detailed clinical and laboratory information is required (67). 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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“…The shock index (SI), which was calculated as SI = HR/systolic blood pressure, is often described in literature as a valid predictor for mortality, as a useful tool for management of triage of patients with multiple trauma. Furthermore, SI has been described to correlate with the length of intensive care unit (ICU) stay, the days of invasive ventilation, the need for transfusion and the development of septic complications in humans [23][24][25][26] . Our results presented in Fig.…”

Section: Discussionmentioning

confidence: 99%

Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

Weber

Lackner

Baur

et al. 2021

Sci Rep

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One third of multiple trauma patients present abnormal echocardiographic (ECHO) findings. Therefore, ECHO diagnostic after trauma is indicated in case of hemodynamic instability, shock, after chest trauma and after cardiac arrest. 20 male pigs underwent multiple trauma. Blood samples were collected 4 and 6 h after trauma and concentrations of heart-type fatty acid binding protein (HFABP) as a biomarker for EMD were measured. Myocardial damage was evaluated by scoring Hematoxylin–Eosin stained sections. At baseline, 3 and 6 h after trauma, transesophageal ECHO (TOE) was performed, invasive arterial and left ventricular blood pressure were measured to evaluate the cardiac function after multiple trauma. Systemic HFABP concentrations were elevated, furthermore heart injury score in multiple trauma animals was increased determining EMD. A significant decrease of blood pressure in combination with a consecutive rise of heart frequency was observed. Ongoing depression of mean arterial pressure and diastolic blood pressure were accompanied by changes in ECHO-parameters indicating diastolic and systolic dysfunction. Furthermore, a valvular dysfunction was detected. In this study complex myocardial and valvular impairment after multiple trauma in pigs has been observed. Therefore, detection of EMD and progressive valvular dysfunction might be crucial and therapeutically relevant.

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The role of shock index as a predictor of multiple‐trauma patients' pathways

Abstract: The results of this study suggest the possibility of using SI in multiple-trauma patients as a triage indicator to assess the patients' care complexity and to guide the choice of proper clinical paths.

Cited by 9 publications

References 32 publications

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

Reaming of femoral fractures with different reaming irrigator aspirator systems shows distinct effects on cardiac function after experimental polytrauma

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

Early myocardial damage (EMD) and valvular insufficiency result in impaired cardiac function after multiple trauma in pigs

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