Elsevier

Surgery

Volume 152, Issue 3, September 2012, Pages 473-476
Surgery

Society of University Surgeons
A prehospital shock index for trauma correlates with measures of hospital resource use and mortality

https://doi.org/10.1016/j.surg.2012.07.010Get rights and content

Background

The assessment and treatment of trauma patients begins in the prehospital environment. Studies have validated the shock index as a correlate for mortality and the identification of shock in trauma patients. We investigated the use of the first shock index obtained in the prehospital environment and the first shock index obtained upon arrival in the trauma center as correlates for other outcomes to evaluate its usefulness as a triage tool.

Methods

This is a retrospective review of data from a level I trauma center. Prehospital and trauma center shock indices for 16,269 patients were evaluated as correlates for duration of hospital stay, duration of stay in the intensive care unit, the number of ventilator days, blood product use, and destination of transfer from the trauma center.

Results

Pearson correlation coefficients revealed that the relationship of prehospital and trauma center shock indices were correlates for duration of hospital stay, duration of stay in the intensive care unit, the number of ventilator days, and blood product use. A chi-square analysis found that shock indices ≥0.9 indicate a higher likelihood of disposition to the intensive care unit, operating room, or death.

Conclusion

A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. A prospective study is needed to determine the use of this measure as a triage tool.

Section snippets

Methods

This study is a retrospective review of trauma registry data from a level I trauma center in Jacksonville, Florida, that serves both rural and urban areas. All trauma patients presenting between January 1, 2006 and December 31, 2010 were evaluated for inclusion. Excluded from the study were patients under 16 years of age, patients with incomplete data, and those not transported directly from the scene by emergency medical services. Data were collected for the 16,269 included patients using the

Results

The mean age of the 16,269 patients included in the study was 38.8 years (range, 16–100). The most common mechanisms of injury were motor vehicle crashes (44.9%), falls (11.2%), gunshot wounds (9.6%), motorcycle crashes (8.7%), pedestrians struck by vehicles (6.3%), and stab wounds (5.8%).

The mean prehospital SI was 0.64, and 3,200 patients had a prehospital SI of ≥0.9. In the trauma center, the mean SI upon arrival was 0.71, and 2,242 trauma center SIs were ≥0.9. These values were

Discussion

Trauma continues to be one of the leading causes of morbidity and mortality in the United States. The current statewide trauma alert guidelines in Florida use respiratory status, Glasgow Coma Scale, tachycardia, presence of long bone fractures, age, and mechanism of injury to guide triage decision-making. The combination of multiple vital signs is not currently used. Also, there are no specific criteria in place to evaluate a patient's need for expedited or possible air transport to a trauma

References (12)

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control web site. Web-based...
  • S.M. Sasser et al.

    Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011

    MMWR Recomm Rep

    (2012)
  • C.M. Cannon et al.

    Utility of the shock index in predicting mortality in traumatically injured patients

    J Trauma

    (2009)
  • K. Grimme et al.

    Calculation of different triage scores based on the German trauma registry

    Eur J Trauma

    (2005)
  • J.B. Holcomb et al.

    Prehospital physiologic data and lifesaving interventions in trauma patients

    Mil Med

    (2005)
  • A.M. Lipsky et al.

    Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department

    J Trauma

    (2006)
There are more references available in the full text version of this article.

Cited by (74)

  • Optimal Prospective Predictors of Mortality in Austere Environments

    2020, Journal of Surgical Research
    Citation Excerpt :

    Of these proposed scoring systems, shock index (SI), defined as heart rate divided by systolic blood pressure (SBP), continues to be one of the most studied tools. SI remains an attractive score because of its ease of calculation as well as its usefulness in predicting mortality, transfusion requirements, hospital and intensive care unit stay, and number of days on the ventilator.7-10 Multiple variations of the SI have recently emerged in an attempt to correct for varying cofactors such as age and traumatic brain injury, which may prove important for outcomes prediction.11-14

View all citing articles on Scopus
View full text