The utility of shock index in differentiating major from minor injury

Abstract

The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. A normal SI should not lower the suspicion of major injury.

Physiologic mechanisms underlying the failure of the “shock index” as a tool for accurate assessment of patient status during progressive simulated hemorrhage

“…Contrary to this hypothesis, we found that the SI was paradoxically lower in LT subjects at any relative reduction in central blood volume compared with that of the HT subjects. Although issues of inconsistent sensitivity in the use of the SI have been suggested based on uncontrolled clinical studies, 1,8,9 we conducted the present investigation using a human experimental model that allowed us to systematically control the progressive loss of central blood volume to the point of cardiovascular decompensation. Our results are consistent with clinical reports in supporting the notion that the SI lacks sensitivity, particularly at low levels of central hypovolemia, in its capacity to identify impending hemodynamic instability in those individuals most at risk for early development of decompensation (e.g., early decompensatory phase of shock).…”

Association of triage time Shock Index, Modified Shock Index, and Age Shock Index with mortality in Emergency Severity Index level 2 patients

“…Utilizing and the potential benefits of SI as a predictor of mortality and Intensive Care Unit (ICU) admission was evaluated by many other studies as well, and its superiority to conventional vital sign measurements were demonstrated in most of them in pre-hospital and in-hospital settings in trauma and medical patients [20][21][22][23]. However, No study has yet focused on evaluating all of these indices (SI, MSI, and Age SI) in one patient population and comparing them with conventional vital sign measurement and with each other in a specific subgroup of triaged patients.…”

Age- and sex-specific normal values for shock index in National Health and Nutrition Examination Survey 1999-2008 for ages 8 years and older

“…Elevated SI has also been shown to predict mortality [2,6,10,11] and need for critical care [10,[12][13][14][15][16] in adults. Studies in children have conflicting results with trauma studies showing an SI predictive of hemorrhagic shock [17] and a composite measure of trauma outcomes [18] with a few SI studies finding no predictive value [19][20][21].…”