Abstract
The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS] ≥ 16) with head injury (head Abbreviated Injury Scale [AIS] ≥ 2) in the emergency department (ED). This retrospective case control study recruited adult severe trauma patients (ISS ≥ 16) with head injury (head AIS ≥ 2) who presented to the ED of two major trauma centers between January 01, 2014 and May 31, 2017. Demographic data, vital signs, ISS scores, injury mechanisms, laboratory data, managements, and outcomes were included for the analysis. Logistic regression and receiver operating characteristic analysis were used to evaluate the accuracy of rSIG score in predicting in-hospital mortality. In total, 438 patients (mean age: 56.48 years; 68.5% were males) were included in this study. In-hospital mortality occurred in 24.7% patients. The median (interquartile range) ISS score was 20 (17–26). Patients with rSIG ≤ 14 had seven-fold increased risks of mortality than those without rSIG ≤ 14 (odds ratio: 7.64; 95% confidence interval: 4.69–12.42). Hosmer–Lemeshow goodness-of-fit test and area under the curve values for rSIG score were 0.29 and 0.76, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of rSIG ≤ 14 were 0.71, 0.75, 0.49, and 0.89, respectively. The rSIG score is a prompt and simple tool to predict in-hospital mortality among adult severe trauma patients with head injury.
Highlights
Trauma, the sixth leading cause of death worldwide and a major cause of morbidity and mortality, includes hemorrhagic shock and traumatic brain injuries[1,2,3,4]
A research group in Taiwan introduced the concept of reverse shock index, defined as the ratio of systolic blood pressure (SBP) to heart rate (HR) and reported that reverse (or inverse) shock index (rSI)
The median (IQR) of Injury Severity Score (ISS) and AIS was significantly higher in the mortality group than in the survival group (2511,17–28 and 1616–25 vs 1816–25 and 169–16, respectively)
Summary
The sixth leading cause of death worldwide and a major cause of morbidity and mortality, includes hemorrhagic shock and traumatic brain injuries[1,2,3,4]. The Glasgow Coma Scale (GCS)[15], which is used to assess consciousness level, has shown to possess strong correlation with mortality in patients with traumatic brain injury[16,17] Considering these characteristics, a Japanese research group has proposed a new scoring tool, rSIG, which was derived from a multicenter retrospective study and calculated by multiplying rSI by GCS score[18]. They found that the rSIG score can discriminate in-hospital mortality risk and is as good as the previous prediction methods that used only vital signs and age[18]. This study aimed to investigate the predictive performance of rSIG for in-hospital mortality in adult severe trauma patients with head injury
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