James M Bardes1, Bradley S Price, Donald A Adjeroh, Gianfranco Doretto, Alison Wilson. 1. From the Division of Trauma, Surgical Critical Care and Acute Care Surgery, Department of Surgery (J.M.B., A.W.), Department of Management Information Systems (B.S.P.), John Chambers College of Business and Economics, and Lane Department of Computer Science and Electrical Engineering (D.A.A., G.D.), Benjamin M. Statler College of Engineering and Mineral Resources, West Virginia University, Morgantown, West Virginia.
Abstract
INTRODUCTION: Shock index (SI) and delta shock index (∆SI) predict mortality and blood transfusion in trauma patients. This study aimed to evaluate the predictive ability of SI and ∆SI in a rural environment with prolonged transport times and transfers from critical access hospitals or level IV trauma centers. METHODS: We completed a retrospective database review at an American College of Surgeons verified level 1 trauma center for 2 years. Adult subjects analyzed sustained torso trauma. Subjects with missing data or severe head trauma were excluded. For analysis, poisson regression and binomial logistic regression were used to study the effect of time in transport and SI/∆SI on resource utilization and outcomes. p < 0.05 was considered significant. RESULTS: Complete data were available on 549 scene patients and 127 transfers. Mean Injury Severity Score was 11 (interquartile range, 9.0) for scene and 13 (interquartile range, 6.5) for transfers. Initial emergency medical services SI was the most significant predictor for blood transfusion and intensive care unit care in both scene and transferred patients (p < 0.0001) compared with trauma center arrival SI or transferring center SI. A negative ∆SI was significantly associated with the need for transfusion and the number of units transfused. Longer transport time also had a significant relationship with increasing intensive care unit length of stay. Cohorts were analyzed separately. CONCLUSION: Providers must maintain a high level of clinical suspicion for patients who had an initially elevated SI. Emergency medical services SI was the greatest predictor of injury and need for resources. Enroute SI and ∆SI were less predictive as time from injury increased. This highlights the improvements in en route care but does not eliminate the need for high-level trauma intervention. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
INTRODUCTION: Shock index (SI) and delta shock index (∆SI) predict mortality and blood transfusion in trauma patients. This study aimed to evaluate the predictive ability of SI and ∆SI in a rural environment with prolonged transport times and transfers from critical access hospitals or level IV trauma centers. METHODS: We completed a retrospective database review at an American College of Surgeons verified level 1 trauma center for 2 years. Adult subjects analyzed sustained torso trauma. Subjects with missing data or severe head trauma were excluded. For analysis, poisson regression and binomial logistic regression were used to study the effect of time in transport and SI/∆SI on resource utilization and outcomes. p < 0.05 was considered significant. RESULTS: Complete data were available on 549 scene patients and 127 transfers. Mean Injury Severity Score was 11 (interquartile range, 9.0) for scene and 13 (interquartile range, 6.5) for transfers. Initial emergency medical services SI was the most significant predictor for blood transfusion and intensive care unit care in both scene and transferred patients (p < 0.0001) compared with trauma center arrival SI or transferring center SI. A negative ∆SI was significantly associated with the need for transfusion and the number of units transfused. Longer transport time also had a significant relationship with increasing intensive care unit length of stay. Cohorts were analyzed separately. CONCLUSION: Providers must maintain a high level of clinical suspicion for patients who had an initially elevated SI. Emergency medical services SI was the greatest predictor of injury and need for resources. Enroute SI and ∆SI were less predictive as time from injury increased. This highlights the improvements in en route care but does not eliminate the need for high-level trauma intervention. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.
Authors: Brendan G Carr; Ariel J Bowman; Catherine S Wolff; Michael T Mullen; Daniel N Holena; Charles C Branas; Douglas J Wiebe Journal: Injury Date: 2017-01-03 Impact factor: 2.586
Authors: T J Esposito; R V Maier; F P Rivara; S Pilcher; J Griffith; S Lazear; S Hogan Journal: Prehosp Disaster Med Date: 1995 Jul-Sep Impact factor: 2.040
Authors: Marc D Trust; Morgan Schellenberg; Subarna Biswas; Kenji Inaba; Vincent Cheng; Zachary Warriner; Bryan E Love; Demetrios Demetriades Journal: Prehosp Disaster Med Date: 2020-03-04 Impact factor: 2.040
Authors: Morgan Schellenberg; Subarna Biswas; James M Bardes; Marc D Trust; Daniel Grabo; Alison Wilson; Kenji Inaba Journal: Am Surg Date: 2020-12-07 Impact factor: 1.002