Abstract
Hemorrhage, a main cause of mortality in patients with trauma, affects vital signs such as blood pressure and heart rate. Shock index (SI), calculated as heart rate divided by systolic blood pressure, is widely used to estimate the shock status of patients with hemorrhage. The difference in SI between the emergency department and prehospital field can indirectly reflect urgency after trauma. We aimed to determine the association between delta SI (DSI) and in-hospital mortality in patients with torso or extremity trauma. Patients with DSI >0.1 are expected to be associated with high mortality. This retrospective, observational study used data from the Pan-Asian Trauma Outcomes Study. Patients aged 18-85 years with abdomen, chest, upper extremity, lower extremity, or external injury location were included. Patients from China, Indonesia, Japan, Philippines, Thailand, and Vietnam; those who were transferred from another facility; those who were transferred without the use of emergency medical service; those with prehospital cardiac arrest; those with unknown exposure and outcomes were excluded. The exposure and primary outcome were DSI and in-hospital mortality, respectively. The secondary and tertiary outcome was intensive care unit (ICU) admission and massive transfusion, respectively. Multivariate logistic regression analysis was performed to test the association between DSI and outcome. In total, 21,534 patients were enrolled according to the inclusion and exclusion criteria. There were 3,033 patients with DSI >0.1. The in-hospital mortality rate in the DSI >0.1 and ≤0.1 groups was 2.0% and 0.8%, respectively. In multivariate logistic regression analysis, the DSI ≤0.1 group was considered the reference group. The unadjusted and adjusted odds ratios of in-hospital mortality in the DSI >0.1 group were 2.54 (95% confidence interval [CI] 1.88-3.42) and 2.82 (95% CI 2.08-3.84), respectively. The urgency of traumatic hemorrhage can be determined using DSI, which can help hospital staff to provide proper trauma management, such as early trauma surgery or embolization.
Highlights
Trauma is the leading cause of morbidity and mortality in all age groups
Delta shock index in torso and extremity trauma transported to the emergency department (ED) of the participating hospitals via typical emergency medical services (EMS) ambulances in developed countries or other types of ambulances in developing countries are included in the Pan-Asian Trauma Outcomes Study (PATOS)
Patients aged 85 years; those with prehospital cardiac arrest; those transferred from another hospital; those who were transferred without the use of EMS; those with anatomical injury in the head, face, neck, and spine; those with unknown prehospital and ED systolic blood pressure (SBP) or heart rate (HR); those with outlying SBP or HR; and those with unknown outcomes were excluded
Summary
Trauma is the leading cause of morbidity and mortality in all age groups. The rate of mortality due to trauma has increased up to 23% [1]. Hemorrhage is one of the most important causes of mortality in preventable deaths after trauma [2]. Trauma deaths after hospital admission are usually related to massive hemorrhage, which can be preventable if detected early by hospital staff [3]. Hemorrhage causes hypovolemic shock, compounded by lactic acidosis, hypothermia, and coagulopathy. Shock status must be corrected by hemostasis via embolization or emergency laparotomy and transfusion therapy [4]
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