Modified Shock Index Research Articles

Comparison of Modified Shock Index and Respiratory Adjusted Shock Index for Mortality in Trauma Patients

Comparison of Modified Shock Index and Respiratory Adjusted Shock Index for Mortality in Trauma Patients

The predictive value of the shock index and modified shock index for the short-term mortality in patients with acute pulmonary embolism

Aim: The purpose of the study was to examine the relationship of shock index (SI) and modified shock index (MSI) with pulmonary embolism severity index (PESI) score in predicting short-term death in acute pulmonary embolism (APE) patients. Material and Methods: This retrospective analysis included 104 consecutive patients whose APE was confirmed using computerized tomographic pulmonary angiography. For each patient, the PESI score, the SI, and the MSI were calculated. The main endpoint of the study was short-term mortality.Results: Patients based on hemodynamic status or the PESI score upon admission were allocated into high risk and non-high risk groups. We noted that SI and MSI were significantly elevated in a high risk group (1.17 ± 0.17 vs. 0.77 ± 0.17 and 1.54 ± 0.29 vs. 1.05 ± 0.21, respectively, p 0.001). In a correlation analysis, we showed that SI and MSI were significantly correlated with the PESI score for short-term mortality (r = 0.491 and r = 0.504, respectively, p 0.001). An area under curve value of SI and MSI for short-term death were 0.66 (0.52-0.79 95% CI, p = 0.022) and 0.67 (0.53-0.80 95% CI, p = 0.026) respectively.Conclusion: The present study findings demonstrated that the SI and MSI may be applicable in predicting short-death in patients with APE.

Coagulation profile tests as a predictor for adult trauma patients’ mortality

Background: Coagulopathy is commonly observed in poly-traumatized patients and is a known contributor to trauma mortality. Although, the incidence of coagulopathy is strongly associated with the severity of the injury, coagulopathy itself exerts an independent factor on mortality.Methods: This is a prospective, observational study on 100 trauma patients. All patients were evaluated using the modified shock index (MSI). Coagulation profile tests including platelet count, prothrombin time (PT), partial thromboplastin time (PTT), D-dimer and fibrinogen/fibrin degradation products (FDPs) were performed for all patients on admission and at 12 hours intervals. Statistically, a logistic regression analysis was performed of coagulation profile tests to determine the incidence of trauma induced coagulopathy (TIC) and its impact on 24 hours mortality. Correlation between clinical and laboratory status was done.Results: There was a statistically significant difference between the dead and the survived patients in the coagulation profile tests and MSI. The best cut-off point of each parameter of coagulation profile tests (PLT count, PT, PTT, d-dimer, FDPs) and MSI was calculated using receiver operating characteristic curve and were <173 × 109/l, >18.7 s, >31 s, >5 mg/l, > 321.5 mg/l and 1.6 respectively. Trauma induced coagulopathy in our study was defined by more than 2 of the following: PLT <173 × 109/l, PT >18.7 s, activated partial thromboplastin time (APTT) >31 s, D-dimer >5 mg/l and FDPs>321.5 mg/l with a p value 0.001 and associated with increased mortality.Conclusions: The incidence of trauma induced coagulopathy early after trauma is high and its severity is related to the injury itself. It is independent predictor of mortality. TIC was developed with presence of more than 2 of the coagulopathy parameters.

Optimal Hemodynamic Parameter to Predict the Neurological Outcome in Out-of-Hospital Cardiac Arrest Survivors Treated with Target Temperature Management.

Current guidelines suggest the maintenance of systolic blood pressure (SBP) at >90 mmHg and mean arterial pressure (MAP) at >65 mmHg in postcardiac arrest patients. There remains a lack of clarity regarding optimal values and timing of blood pressure parameters associated with the improvement of neurologic outcome. We investigated the association of time-weighted average (TWA) blood pressure parameters with favorable neurological outcome (FO) in postcardiac arrest patients. This was a registry-based observational study with consecutive adult out-of-hospital cardiac arrest (OHCA) survivors who were treated using targeted temperature management (TTM). During 72 hours of TTM period, we abstracted hemodynamic parameters such as SBP, diastolic blood pressure, pulse rate (PR), and MAP. Shock index (SI; PR/SBP) and modified shock index (MSI; PR/MAP) were calculated from each measured hemodynamics. Logistic regression was performed to assess the associations between TWA blood pressure parameters and FO, defined as cerebral performance category 1 or 2 at hospital discharge. Among the 173 patients (median age: 58 years; 64% male), 51 (29.3%) had FO in this study. MAP, SI, and MSI at 6 hours after return of spontaneous circulation (ROSC) showed considerable differences in patients with FO (MAP: 89.1 ± 14.7 vs. 83.6 ± 15.8 mmHg, p = 0.033, SI: 0.7 ± 0.2 vs. 0.9 ± 0.9, p = 0.002, MSI: 1.0 ± 0.3 vs. 1.2 ± 0.3, p ≤ 0.001). Among them, MSI, especially at 6 hours, had the highest area under the curve for prediction of FO (0.685; 95% confidence interval: 0.597-0.772, p < 0.001). Also, MSI <1.0 had a sensitivity of 64.7%, a specificity of 64.2% to predict FO. In comatose survivors of OHCA with TTM, MSI at 6 hours after ROSC had the highest prognostic value for neurologic outcome among blood pressure parameters.

273 Modified Shock Index and Neurologic Outcome During Treated Target Temperature Management in Out-of-Hospital Cardiac Arrest Survivors

Current guidelines suggest the maintenance of systolic blood pressure (SBP) at >90mmHg and mean arterial pressure (MAP) at >65mmHg in post-cardiac arrest patients. There remains a lack of clarity regarding optimal values and timing of blood pressure parameters associated with the improvement of neurologic outcome. We investigated the association of time-weighted average blood pressure parameters with favorable neurological outcome (FO) in post-cardiac arrest patients.

Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department

IntroductionHypotension after emergent ETI is a relatively common complication during and after emergency airway management. We aimed to evaluate SI, MSI, and age SI to predict PIH in patients who presented to the emergency department. Moreover, which factors would be better for predicting the event or similar to the others. MethodsA retrospective, standardized chart review of consecutive ED patients requiring intubation at an urban, tertiary-care teaching hospital, from January 2011 to December 2016. PIH was defined as any recorded SBP <90 mmHg or MAP <65 mmHg within the 60-minute period after intubation. ResultsHypotension after emergent ETI was observed in 130 (29.7%) patients. The ROC-AUC of age SI, MSI, and SI before intubation for prediction of PIH were 0.676 (95% CI 0.63–0.72), 0.614 (95% CI 0.567–0.66), and 0.611 (95% CI 0.564–0.657). The prognostic performance of age SI for prediction of PIH was better than MSI and SI (p = 0.006 for age SI versus MSI, p = 0.005 for age SI versus SI). ConclusionsPreintubation age SI, MSI, and SI are all independent predictors of PIH in patients who need emergent intubation. Aong these parameters, age SI is the best marker to predict the outcome. Calculation of these indexes are simple and could be an guide of implement to prevent hypotension after ETI.

Comparison of risk scores and shock index in hemodynamically stable patients presenting to the emergency department with nonvariceal upper gastrointestinal bleeding.

Risk assessment in nonvariceal upper gastrointestinal bleeding (UGIB) is not well validated and remains unclear in hemodynamically stable patients at emergency department admission. We compared the prognostic value of risk-scoring systems for predicting adverse outcomes in patients with nonvariceal UGIB and normotension. A single-center prospective observational study was carried out. Patients with consecutive nonvariceal UGIB, presenting with normotension (systolic blood pressure ≥90 mmHg) to the emergency department, were included. We compared the areas under the curves (AUC) of Glasgow Blatchford score (GBS), the pre-endoscopy Rockall score, AIMS65, the shock index, and the modified shock index with respect to adverse outcomes defined as embolization, surgery, ICU admission, rebleeding, and in-hospital mortality. In total, 1233 patients were included. Adverse outcomes occurred in 165 (13.4%) patients; in-hospital mortality was 1.2%. AUC of the GBS for adverse outcome was higher than that of the shock index, but not significantly different (0.647 vs. 0.569, P=0.23). AUC values of the modified shock index, AIMS65, and the pre-endoscopy Rockall score were 0.565, 0.593, and 0.533, respectively. The cut-off value of the GBS (≥8) was associated with 85% sensitivity and 35% specificity for predicting adverse outcome. Pre-existing risk scores have shown suboptimal predictive ability for adverse events in normotensive patients with nonvariceal UGIB. The GBS (≥8) might help to identify patients prone to adverse events; however, further studies with risk scores or new scores are needed because of the low accuracy of these scores.

Shock index and modified shock index as triage screening tools for sepsis

BackgroundFever is one of the common conditions encountered in the emergency department, which related to a spectrum of diseases severity. Identifying sepsis patients from uncomplicated febrile patients is challenging in the emergency triage areas and pre-hospital settings. ObjectivesAssess the triage shock index (SI) and modified shock index (MSI) in febrile patients as predictors for sepsis and sepsis-related outcomes. DesignA retrospective cohort study. SettingPatients presented to the Emergency Department of King Khalid University Hospital. Patients and methodsThe analysis included all febrile adult patients triaged with a temperature of 38 °C or more from January 2016 to December 2017. Based on triage vital sign we calculate the SI with cut-off levels of ≥0.7 and ≥1 and MSI with cut-off levels of ≥1 and ≥1.3. We report the Relative Risk, Sensitivity, Specificity, Positive and Negative Predictive Values of the predictors. Main outcome measuresSepsis and sepsis-related outcomes such as hyperlactatemia, ICU admission, and 28 days mortality. Sample size274 patients. Results274 patients met our inclusion/exclusion criteria. Of the 274 patients, 252 patient (92%) were septic, 62 patients (22%) had hyperlactatemia, 20 patients admitted to the ICU, and 5 patient died within 28 days. An MSI of ≥1 had a sensitivity of 90% for sepsis predication, 85% for ICU admission and 100% for 28 days mortality. MSI of ≥1.3 showed a specificity (59%–100%) for all the outcomes of interest. Non-significant statistical trends of greater accuracy of MSI over SI. ConclusionMSI and SI were found to be promising predictors in triaging febrile patients. However no single cut-off values of MSI or SI were found to have an optimal accuracy for prediction of sepsis and sepsis-related outcomes. Further studies are required to assess the incorporation of MSI in a multi-item scaling system for the prediction of sepsis and its related outcomes. LimitationsSmall single center study and the results may not be generalizable.

Comparison of the shock index, modified shock index, and age shock index in adult admissions to a tertiary hospital

Background: Multiple variables interact constantly to maintain the hemodynamic statusof patients. The shock index (SI), the modified shock index (MSI), and the age shock index(ASI) have been studied in different clinical settings to predict hemodynamic instability andassociated outcomes. These indices are calculated from simple hemodynamic parameters,are non-invasive, and represent no additional expense. We wanted to analyze the performanceof these three different indices in the patients admitted to our hospital.Methods: We performed a retrospective study in which we identified all adult patients(&gt;18 years, &lt;89 years) admitted to the University Medical Center in Lubbock, Texas, from10/01/2015 until 9/30/2016. We collected basic clinical information, including age, initialblood pressure measurements, discharge diagnoses, length of stay (LOS), and mortality.With these variables we calculated for each patient the admission SI (defined as heart rate/systolic blood pressure), MSI (heart rate/mean arterial pressure), and ASI (age × SI). Weseparated the patients according to their admission diagnoses and calculated the median and25th–75th percentiles for those parameters. We also compared mortality and LOS based ontheir admission SI using two different cutoff points at 0.7 and 1.0, their admission MSI (cutoff:1.3), and their ASI (cutoff: 50).Results: A total of 18,478 adult patients admitted to our institution were included in thisstudy. The median age was 53 years, the median LOS was 4 days, and the overall mortalitywas 3.8%. The median SI was 0.67; 43.3% of patients had an SI &gt; 0.7 and 8.11% had anSI &gt; 1.0. The median SI calculated for the patients with sepsis was 0.88; this was higher than therest of admission diagnoses (p &lt; 0.001). The mortality of the patients with an SI &gt; 0.7 was 5.1%and with SI &gt; 1.0 was 11.3% (p &lt; 0.001). When comparing the MSI, those with an MSI &gt; 1.3 hada mortality of 10.3%, and those with an ASI &gt; 50 had a mortality of 10.0% (p &lt; 0.001).Conclusions: The SI, MSI, and ASI are non-invasive calculations that may provide usefulinformation when triaging patients early during admission. The diagnosis of sepsis results in ahigher median SI, which may represent better prediction in outcomes compared with the restof admission diagnoses. In our study, the three indexes performed equally. Since the SI witha cut-off of 1.0 identified patients with higher mortality risk, we would recommend using thiscut-off instead of 0.7.

Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients

BackgroundModified shock index (MSI) is a useful predictor in trauma patients. However, the value of prehospital MSI (preMSI) in trauma patients is unknown. The aim of this study was to investigate the accuracy of preMSI in predicting massive transfusion (MT) and hospital mortality among trauma patients. MethodsThis was a retrospective, observational, single-center study. Patients presenting consecutively to the trauma center between January 2016 and December 2017, were included. The predictive ability of both prehospital shock index (preSI) and preMSI for MT and hospital mortality was assessed by calculating the areas under the receiver operating characteristic curves (AUROCs). ResultsA total of 1007 patients were included. Seventy-eight (7.7%) patients received MT, and 30 (3.0%) patients died within 24 h of admission to the trauma center. The AUROCs for predicting MT with preSI and preMSI were 0.773 (95% confidence interval [CI], 0.746–0.798) and 0.765 (95% CI, 0.738–0.791), respectively. The AUROCs for predicting 24-hour mortality with preSI and preMSI were 0.584 (95% CI, 0.553–0.615) and 0.581 (95% CI, 0.550–0.612), respectively. ConclusionsPreSI and preMSI showed moderate accuracy in predicting MT. PreMSI did not have higher predictive power than preSI. Additionally, in predicting hospital mortality, preMSI was not superior to preSI.

Clinical benefits of shock index and modified shock index in pulmonary embolism for 30-day mortality prognosis

Aim: It was evaluating the shock index and the modified shock index, which are strongly correlated with the severity of the shock. Determining the risk analysis in terms of early mortality of patients diagnosed with pulmonary thromboembolism (PE) in order to specify treatment options and prognosis. Therefore, it is important to determine the severity of pulmonary embolism correctly. The available algorithms, such as the pulmonary embolism severity index, provide a prediction of the patients according to clinical findings. These algorithms score abnormal vital signs, medical findings, age, and comorbid diseases. However, vital signs in normal physiological limits cause errors in determining the severity of the disease. In this case, the problem is a lack of correlation between the severity of the disease and vital signs. Consequently, we need a more reliable parameter. In our study, we searched for a parameter that can be calculated easily in a dynamic manner, and which is not affected by normalized vital signs. We attempted to find a parameter that could indicate the severity of the disease. Therefore, we evaluated the shock index and the modified shock index, which are strongly correlated with the severity of the shock.Material and Methods: Patients diagnosed with pulmonary embolism were screened retrospectively between January 2012 and December 2017. A total of 99 patients whose pulmonary embolism was confirmed by angio-thoracic tomography were included in the study. Heart rate, systolic and diastolic blood pressure were measured in these patients. Mean arterial pressure, shock index and the modified shock index were also calculated. The values showing the severity of the disease were evaluated.Result When all the parameters were examined, the predictive power of deaths within 30 days was significant at differing degrees (p0.05). In ROC analysis, shock index was the most prominent parameter with its clinical utility and sensitivity. This was followed by pulse count and modified shock index, which are other valuable parameters.Conclusion: At the time of admission to the emergency department, we found that the shock index could be easily calculated with vital signs and display a better correlation with the severity of the disease. Although systolic-diastolic blood pressure, pulse rate and mean arterial pressures calculated in pulmonary embolism are within physiological limits, the shock index shows particularly better correlation and sensitivity of the severity of the disease.Keywords: Pulmonary embolism; shock index; modified shock index.

The relationship of shock index, modified shock index, and age shock index with mortality in the intensive care unit Care Unit

Aim: Shock indexes are associated with clinical outcomes of patients, particularly in the emergency department. The present study aimed to evaluate the predictive capacity of Shock Index, Modified Shock Index, and Age Shock Index in terms of mortality in patients admitted to intensive care units.Material and Methods: All patients (aged >18 years) admitted to intensive care unit between January 01, 2018 and October 31, 2018 were included. Vital signs at the time of hospitalization were used to calculate Shock Index, Modified Shock Index, and Age Shock Index. Patients with shock were divided into three groups: Group 1 (septic shock), Group 2 (hypovolemic shock), and Group 3 (cardiogenic shock). The primary outcome was to evaluate intensive care unit mortality.Results: Mortality was 37% among 308 patients included in the study. Shock Index, Modified Shock Index, and Age Shock Index levels were significantly higher in patients with mortality (p 0.05). Shock Index, Modified Shock Index, and Age Shock Index levels were significantly higher than normal range in Group 1, 2, and 3 (p 0.05).Conclusion: All three shock indices were observed to be high in all patients with shock, and three shock indices were similarly significant in predicting mortality in patients admitted to intensive care units.

Correlation between modified shock index and severity index in predicting outcome in patients with hemorrhagic shock

Introduction Trauma is the main cause of death in age group less than 45 years. A lot of clinical parameters including heart rate, pulse rate, blood pressure, shock index (SI), and modified shock index (MSI) are used to predict the severity of hemorrhage in trauma patients. In 2012 Choi and colleagues proposed for the first time a new index (NI) based on lactate concentration and peripheral perfusion index for assessment of shock in a rat model. In this trial, we propose for the first time a new severity predicting index (NI) based on lactate concentration/peripheral perfusion ratio as an indicator of hemorrhage-related mortality in humans. Materials and methods This prospective trial is a single-center study of 122 consecutive adult polytraumatized patients with hemorrhagic shock admitted to trauma center within 6 h of the trauma, and underwent resuscitation according to the advanced trauma life support protocol (2016). Protocol-related measurements were obtained immediately after admission and over 48 h postresuscitation for metabolic perfusion parameters, serum lactate, perfusion index, and other hemodynamic parameters. The period of the study corresponds to the outcome after 48 h of admission. Resuscitation measures were considered successful when lactate levels were less than or equal to 2 mmol/l in addition to stable macrohemodynamic parameters at the end of this period. Results Characteristically, the survivors had NI of 40 ± 2.7 on admission, compared with 87.1 ± 13 of nonsurvivors with highly significant difference. MSI showed a significant difference (nearly doubled) between survivors and nonsurvivors. SI showed nearly the same change, nearly doubled. NI showed lower prediction value for mortality than MSI and SI (P = 0.05) 0.884, 0.905, and 0.908, respectively. Conclusion This study confirms, for the first time in humans, the validity of severity index as independent parameter in prediction of mortality in comparison with MSI.

Modified Shock Index as a Simple and Strong Predictor of In-Hospital Mace among Patients with St-Segment Elevation Myocardial Infarction

Modified Shock Index as a Simple and Strong Predictor of In-Hospital Mace among Patients with St-Segment Elevation Myocardial Infarction

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

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.

Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation

Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation

Nitroglycerin Patch in Traumatic Hemorrhagic Shock to Improve Signs of Poor Peripheral Perfusion

AbstractBackground: Microcirculatory function is the main pre-requisite for adequate tissue oxygenation and organ function. It transports oxygen and nutrients to tissue cells, ensure adequate immunological function and, in disease, delivers therapeutic drugs to target cells. Recruiting microcirculation, i.e., non-perfused or intermittently perfused capillaries might improve tissue perfusion, mitigating the progression to organ failure and death. Nitroglycerin has been used in different shock states particularly in sepsis. The effect is variable and debatable suggesting an improvement of microcirculation.Patients and Methods: 60 adult patients with hemorrhagic shock admitted to the Emergency Department within 6 hours of trauma event, resuscitation immediately started according to advanced trauma life support ATLS® protocol 2016 with control of the bleeding source. Nitroglycerine patch 5mg applied to patients after the first hour of resuscitation. The study period corresponded to the outcome of the first 48 hours of trauma unit or ICU resuscitation. Patients considered successfully resuscitated if they had normal lactate levels (£2mmol/L).Results: 60 patients enrolled in this study, 10 patients were excluded; 3 of them due to uncontrolled bleeding and 7 due to marked hypotension. 50 patients continued in the study (38 men, 12 women) with mean age was (29.1±10.8ys); of them 45 survived (90%) and 5 did not survive (10%). Patients received mean crystalloid volume (6100±1410.67ml), mean colloid volume (490±457.25ml), mean packed RBCs (4.34±1.33 units), mean fresh frozen plasma (3.08±1.65 units) and mean nor-adrenaline dose (7.94±10.55mg/kg/minute). Baseline perfusion index was (0.37±0.21), mean heart rate (128.46±18.18 beat/minute), systolic blood pressure (78.08± 7.47mmHg), diastolic blood pressure (40.20±7.39mmHg), mean arterial pressure (53.44±6.43mmHg), central venous pressure (–1 .46±2.77cmH2O) and baseline modified shock index was (2.45±0.56). Baseline serum lactate was (8.61±1.86 mmol/L), base deficit was (–12.59±5.57). Perfusion index showed statistically significant increase in survivors than non survivors at 12, 18, 24, 30, 36, 42, 48 hours (p<0.001). Serum lactate level was significantly higher in non survivors group than survivor group (p<0.001). Base deficit was significantly higher in non survivors than survivors (p<0.001). Conclusion: Use of nitroglycerin patch 5mg improved PI at 6 to 48 hours post resuscitation and reduce mortality rate (in this study was 10%) while in other previous studies with the same sample size of hemorrhagic shock patients without use of nitroglycerin it was higher (about 30%).This study is registered at www.clinicaltrials.gov under number NCT03235921.

Modified shock index: A bedside clinical index for risk assessment of ST-segment elevation myocardial infarction at presentation

IntroductionPrompt identification of higher-risk patients presenting with ST-segment elevation myocardial infarction (STEMI) is crucial to pursue a more aggressive approach. ObjectiveWe aimed to assess whether the modified shock index (MSI), the ratio of heart rate to mean arterial pressure, could predict six-month mortality among patients admitted with STEMI. MethodsA retrospective observational cohort study was performed in a single center including 1158 patients diagnosed with STEMI, without cardiogenic shock on admission, between July 2009 and December 2014. They were divided into two groups: group 1 – patients with MSI<0.93 (72%); group 2 – patients with MSI≥0.93 (28%). The primary endpoint was six-month all-cause mortality. ResultsMSI≥0.93 identified patients who were more likely to have signs of heart failure (p=0.002), anemia (p<0.001), renal insufficiency (p=0.014) and left ventricular systolic dysfunction (p=0.045). They more often required inotropic support (p<0.001), intra-aortic balloon pump (p<0.001) and mechanical ventilation (p<0.001). Regarding in-hospital adverse events, they had a higher prevalence of malignant arrhythmias (p=0.01) and mechanical complications (p=0.027). MSI≥0.93 was an independent predictor of overall six-month mortality (adjusted HR 2.00, 95% CI 1.20-3.34, p=0.008). ConclusionMSI was shown to be a valuable bedside tool which can rapidly identify high-risk STEMI patients at presentation.

Validity of Shock Index, Modified Shock Index, Central Venous Pressure and Inferior Vena Cava Collapsibility Index in Evaluation of Intravascular Volume among Hypovolemic Egyptians Patients.

Introduction: assessment of intravascular volume is an important component in care of hypovolemia. Physical examination is inaccurate tools in the assessment of intravascular volume, leading to the need for more objective method and accuracy tool. Aims: the prediction of Validation of Shock Index, Modified Shock Index, Central Venous Pressure and Inferior Vena Cava collapsibility index in Assessment of Intravascular Volume. Methods:-This study was conducted as cross-sectional, observational study on 150 Egyptians patients attending to the Emergency Room with hypovolemia state (systolic blood pressure 100 beat /min and capillary refill >2 sec. and clinical signs with symptoms suggestive any types of shocks.) and all patients enter resuscitation room once they arrive to ER. With Applied resuscitations guidelines methods and treat all the life threading conditions if present to all participants. Results: The studied patients revealed negative correlation between CVP value and (SI and MSI) but positive correlation with IVC-CI value. And the mean CVP was 3.2 ± 2.2 but the mean collapsibility index of IVC was74.9 ± 10.5%. MSI has 100% sensitivity and 98% specificity,CVP has 100% sensitivity and specificity and IVC-CI has 100% sensitivity and specificity in diagnosis of hypovolemia when > 1.3 ,≤ 8 cmH2O and ≥ 50 % respectively. Conclusion: assessment of intravascular volume is an important diagnostic tools and management of hypovolemic patients with determining collapsibility (greater than 50%) of the inferior vena cava by bedside ultrasonography in conjunction with common clinical markers predictors e.g. Shock Index, Modified Shock Index and Central Venous Pressure.

Prediction of massive bleeding. Shock index and modified shock index

ObjectiveTo determine the predictive value of the shock index and modified shock index in patients with massive bleeding due to severe trauma. DesignRetrospective cohort. SettingSevere trauma patient's initial attention at the intensive care unit of a tertiary hospital. SubjectsPatients older than 14 years that were admitted to the hospital with severe trauma (injury severity score >15) form January 2014 to December 2015. VariablesWe studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV−), positive and negative likelihood ratio (LR+ and LR−), ROC curves (receiver operating characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage. Results287 patients were included, 76.31% (219) were male, mean age was 43.36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21–34). The overall frequency of massive bleeding was 8.71% (25). For shock index: AUROC was 0.89 (95% confidence intervals [CI] 0.84–0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2–97.58) and Sp was 79.69% (95% CI: 74.34–84.16). For the modified shock index: AUROC was 0.90 (95% CI: 0.86–0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01–99.23) and Sp was 75.78% (95% CI: 70.18–80.62). ConclusionShock index and modified shock index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma.