Prehospital shock index, modified shock index, and pulse pressure heart rate ratio as predictors of massive blood transfusions in modern warfare injuries: A retrospective analysis

Abstract

BackgroundMassive hemorrhage is the leading preventable cause of death in modern warfare injuries. Early and accurate detection of source of hemorrhage and massive blood transfusions remain the mainstay of management in such cases. Hemodynamic indices like shock index (SI), modified shock index (MSI), and pulse pressure heart rate (PP/HR) ratio have shown promising results in predicting massive transfusion in trauma patients. The present study aimed at assessing the accuracy of SI, MSI, and PP/HR ratio to predict the requirement of massive blood transfusions. MethodsA retrospective analysis was done from 1st January 2016 to 31st December 2016 of the data taken from the trauma register of our hospital. Data were analyzed, and scores of SI, MSI, and PP/HR ratio were evaluated using area under receiver operating curves (AUROCs). Massive transfusion was defined as requirement of ≥10 packed red blood cells (PRBCs) in the first 24 hours or ≥4 PRBCs in first hour of hospital admission. ResultsOf the 326 warfare casualties received, a total of 254 patients were enrolled, and 51(23%) patients required massive transfusion on arrival. SI had an AUROC value of 0.798 (95% confidence interval [CI] = 0.739–0.848) which is comparable to MSI at 0.787 (95% CI = 0.728–0.839) and PP/HR ratio with a value of 0.744 (95% CI = 0.681–0.800), (p<0.001). ConclusionSI, MSI, and PP/HR ratio are equally efficient in predicting massive transfusion in warfare injuries and can be used as rapidly available marker for prediction of massive transfusion in warfare injuries which can be lifesaving and time-saving.