Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

Fligor, Scott C; Hamill, Mark E.; Love, Katie M.; Collier, Bryan R.; Lollar, Dan; Bradburn, Eric H.

doi:10.1177/000313481608200730

Cited by 15 publications

(11 citation statements)

References 20 publications

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“…Isolated vital signs, such as HR or SBP, are unreliable in the assessment of hypovolemic shock. HR alone does not predict the need for MT [11,22]. In contrast, SI has been shown to better risk-stratify patients for critical bleeding, increased transfusion requirements and early mortality [11,23].…”

Section: Discussionmentioning

confidence: 99%

“…Bruijns et al reported that the use of the difference between ED and prehospital SBP, respiratory rate, and SI is good predictor of 48-hours mortality in trauma and may supplement decisions on trauma treatment [24]. Fligor et al reported that MT in geriatric trauma patients can be reliably and simply predicted by the arrival vital signs of SBP, pulse pressure, diastolic blood pressure, and SI [22]. The majority of studies have assessed predictive properties of the SI for patients to require at least 10 units PRBC in the rst 24 hours.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

Park

Lee²,

Kim

et al. 2020

Preprint

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Background : Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age or antihypertensives. Methods : This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. Results : We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 (29.4%) hypertensive patients. MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for the prediction of MT in patients who were older than 65 years who were not taking antihypertensives. Conclusions : The triage of trauma patients is based on the identification of clinical features that are readily identifiable by first responders. However, age and medications may also affect accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

Park

Lee²,

Kim

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Isolated vital signs, such as HR or SBP, are unreliable in the assessment of hypovolemic shock. HR alone does not predict the need for MT [11,22]. In contrast, SI has been shown to better riskstratify patients for critical bleeding, increased transfusion requirements and early mortality [11,23].…”

Section: Discussionmentioning

confidence: 99%

“…Bruijns et al reported that the difference between ED and prehospital SBP, respiratory rate, and SI are good predictor of 48-hours mortality in trauma and may supplement decisions on trauma treatment [24]. Fligor et al reported that MT in geriatric trauma patients can be reliably and simply predicted by the arrival vital signs of SBP, pulse pressure, diastolic blood pressure, and SI [22]. Most studies have assessed predictive properties of SI for requiring at least 10 units of PRBC in the rst 24 hours.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

Park

Lee

Kim

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Systolic blood pressure (SBP) and shock index (SI) are accurate indicators of hemodynamic instability and the need for transfusion in trauma patients. We aimed to determine whether the utility and cutoff point for SBP and SI are affected by age and antihypertensives. Methods: This was a retrospective observational study of a level 1 trauma center between January 2017 and December 2018. We analyzed the utility and cutoff points of SBP and SI for predicting massive transfusion (MT) and 30-day mortality according to patients’ age and whether they were taking antihypertensives. A multivariable logistic regression analysis was conducted to estimate the association of age and antihypertensives on primary and secondary outcomes. Results: We analyzed 4681 trauma cases. There were 1949 patients aged 65 years or older (41.6%), and 1375 hypertensive patients (29.4%). MT was given to 137 patients (2.9%). The 30-day mortality rate was 6.3% (n = 294). In geriatric trauma patients taking antihypertensives, a prehospital SBP less than 110 mmHg was the cutoff value for predicting MT in multivariate logistic regression analyses; packed red blood cell transfusion volume decreased abruptly based on prehospital SBP of 110 mmHg. Emergency Department SI greater than 1.0 was the cutoff value for predicting MT in patients who were older than 65 years and were not taking antihypertensives. Conclusions: The triage of trauma patients is based on the identification of clinical features readily identifiable by first responders. However, age and medications may also affect the accurate evaluation. In initial trauma management, we must apply SBP and SI differently depending on age, whether a patient is taking antihypertensives, and the time at which the indicators are measured.

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“…Vital signs alone have proven insufficient in reliably predicting need for MT [2, 3]. The shock index (SI), the ratio of heart rate (HR)/ systolic blood pressure (SBP), has been considered as a marker for significant injury in trauma patients with hypovolemic shock [4], requirement for transfusion [5], and need for MT [3, 6, 7]. The dynamic change in the ratio of HR to SBP reflect the physiological response of an individual to the trauma injury [8–12].…”

Section: Introductionmentioning

confidence: 99%

Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

Rau

Kuo

et al. 2019

PLoS ONE

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Background The shock index (SI) is defined as the ratio of heart rate/systolic blood pressure. This study aimed to determine the performance of delta shock index (ΔSI), a difference between SI upon arrival at the emergency room (ER) and that in the field, in predicting the need for massive transfusion (MT) among adult trauma patients with stable blood pressure. Methods This study included registered data from all trauma patients aged 20 years and above who were hospitalized from January 1, 2009 to December 31, 2016. Only patients who were transferred by emergency medical service from the accident site with a systolic blood pressure ≥ 90 mm Hg at the ER were included. The 7,957 enrolled trauma patients were divided into 2 groups, those who had received blood transfusion ≥ 10 U (MT, n = 82) and those who had not (non-MT, n = 7,875). The odds ratios with 95% confidence intervals for the need for MT by a given ΔSI were measured. The plot of specific receiver operating characteristic (ROC) curves was used to evaluate the best cutoff point of ΔSI that could predict the patient’s probability of receiving MT. Results ROC curve analysis showed that a ΔSI of 0.06 as the cutoff point had the highest AUC of 0.61, with a sensitivity of 0.415 and specificity of 0.841. Patients with a ΔSI ≥ 0.00 had a significant 1.8-fold increase in need for MT than those patients with a ΔSI less than 0.00 (1.4% vs. 0.8%, p = 0.01). The larger the ΔSI, the higher the odds of need for an MT. Using the cutoff point of ΔSI of 0.06, patients with a ΔSI ≥ 0.06 had a significant 3.7-fold increase in need for MT than those patients with a ΔSI less than 0.06 (2.7% vs. 0.7%, p < 0.001). Conclusions This study indicated that, in trauma patients with stable blood pressure at the ER, the accuracy of prediction of the requirement for MT by ΔSI is low. However, the size of the delta is significantly associated with need for MT and a lack of improvement in the patient’s SI at the ER compared to that in the field significantly increases the odds of a need for MT.

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Vital Signs Strongly Predict Massive Transfusion Need in Geriatric Trauma Patients

Cited by 15 publications

References 20 publications

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

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