BACKGROUND: The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury. Because age negatively impacts physiological reserve, we hypothesized that age multiplied by SI (Age x SI) would be a better predictor of 48 h mortality (48 MORT) compared to heart rate (HR), systolic blood pressure (SBP), or SI. METHODS: A Level I trauma center registry was used to identify victims of blunt injury, aged 18-84 (YOUNG < or =55 and OLD >55) admitted from 1996-2005. Patients with head and spinal cord injury injuries were excluded. The main outcome was 48 MORT. Areas under the receiver operating characteristic curves (AUC) for each predictor were determined. RESULTS: Sixteen thousand seventy-seven patients were identified. Forty-eight MORT was 1.27% (0.93% in YOUNG and 3.17% in OLD; P < 0.0001). Overall, SI (AUC 0.812) and Age x SI (AUC 0.831) were better predictors of 48 MORT compared to HR (AUC 0.716, P < 0.0001) or SBP (AUC 0.753, P = 0.0004) alone. In OLD patients, AGE x SI (AUC 0.828) was a better predictor of 48 MORT compared to HR (AUC 0.659 P < 0.0001), SBP (AUC 0.762 P = 0.003), or SI (AUC 0.787 P = 0.0005). CONCLUSION: SI and Age x SI are better predictors of 48 MORT in injured patients than HR or SBP alone. SI and Age x SI should be used to identify patients at risk for early mortality following injury.
BACKGROUND: The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury. Because age negatively impacts physiological reserve, we hypothesized that age multiplied by SI (Age x SI) would be a better predictor of 48 h mortality (48 MORT) compared to heart rate (HR), systolic blood pressure (SBP), or SI. METHODS: A Level I trauma center registry was used to identify victims of blunt injury, aged 18-84 (YOUNG < or =55 and OLD >55) admitted from 1996-2005. Patients with head and spinal cord injury injuries were excluded. The main outcome was 48 MORT. Areas under the receiver operating characteristic curves (AUC) for each predictor were determined. RESULTS: Sixteen thousand seventy-seven patients were identified. Forty-eight MORT was 1.27% (0.93% in YOUNG and 3.17% in OLD; P < 0.0001). Overall, SI (AUC 0.812) and Age x SI (AUC 0.831) were better predictors of 48 MORT compared to HR (AUC 0.716, P < 0.0001) or SBP (AUC 0.753, P = 0.0004) alone. In OLD patients, AGE x SI (AUC 0.828) was a better predictor of 48 MORT compared to HR (AUC 0.659 P < 0.0001), SBP (AUC 0.762 P = 0.003), or SI (AUC 0.787 P = 0.0005). CONCLUSION: SI and Age x SI are better predictors of 48 MORT in injured patients than HR or SBP alone. SI and Age x SI should be used to identify patients at risk for early mortality following injury.
Authors: Kamil Hanna; Charles Harris; Marc D Trust; Andrew Bernard; Carlos Brown; Mohammad Hamidi; Bellal Joseph Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Rodolfo Carvalho Pacagnella; João Paulo Souza; Jill Durocher; Pablo Perel; Jennifer Blum; Beverly Winikoff; Ahmet Metin Gülmezoglu Journal: PLoS One Date: 2013-03-06 Impact factor: 3.240
Authors: Zainali S Chunawala; Michael E Hall; Sameer Arora; Xuming Dai; Venu Menon; Sidney C Smith; Kunihiro Matsushita; Melissa C Caughey Journal: Eur Heart J Acute Cardiovasc Care Date: 2021-10-27