Value Of Shock Index Research Articles

Shock Index as a Predictor of Postpartum Hemorrhage After Vaginal Delivery: Secondary Analysis of a Multicenter Randomized Controlled Trial

(BJOG. 2024;131:343–352. doi: 10.1111/1471-0528.17634) A reliable predictive indicator of postpartum hemorrhage (PPH) could be a significant medical advance. Shock index (SI) is a measurement dividing heart rate (bpm) by systolic blood pressure (mmHg), with a healthy individual usually between 0.5 and 0.7 and the cutoff, where morbidity and mortality is expected, at 0.9. Elevated SI values have been associated with various cardiovascular conditions including hypovolemia and left heart dysfunction. Previous studies have shown values in the immediate postpartum period to range from 0.5 to 0.9, although these studies excluded women who experienced PPH. Additional research suggests the potential for SI to be used as an early sign of PPH, with a range of 0.9 and 1.0; however, the SI included for each patient was their highest in the postpartum period, which technically means the value is being used as a detection tool rather than a predictor. SI is currently recommended as a tool for PPH management.

Prognostic Value of Shock Index, Modified Shock Index, and Age Shock Index in Patients with Sepsis in the Intensive Care Unit

Objective: We aimed to evaluate the usability of the Shock Index (SI), Modified Shock Index (MSI), and Age Shock Index (ASI) in predicting clinical outcomes and mortality in sepsis patients followed in the intensive care unit. Methods: Records of patients admitted to the intensive care unit of Muş State Hospital between January 2022, and April 2024, who developed sepsis were retrospectively recorded from the hospital data system. Results: A total of 127 patients were included in the study. The average age of these patients was found to be 50.83±12.01 years. The average age of discharged patients was 46.14±10.12 years, while the average age of deceased patients was 58.54±10.89 years. In the gender distribution, 63.78% of all patients were male and 36.22% were female (p=0.028). SI was determined as 0.88±0.33 in discharged patients and 1.11±0.32 in deceased patients (p=0.0002). MSI was found to be 1.45±0.33 in discharged patients and 1.68±0.32 in deceased patients (p=0.00001). ASI was determined as 40.73±18.41 in discharged patients and 64.94±22.85 in deceased patients (p=0.0001). The cut-off value for SI was found to be 0.76, with an AUC value of 0.69. The cut-off value for the MSI was determined to be 1.35, with an AUC value of 0.72. The cut-off value for the ASI was found to be 38.76, with an AUC value of 0.85. Conclusion: All three shock indices were statistically significant in predicting mortality in sepsis patients. We believe they are valuable indices that can be used bedside and non-invasively in intensive care units.

Evaluation of Glaskow-Blatchford, Rockall Scores and Shock Index of Patients Admitted from the Emergency Department with A Diagnosis of Upper Gastrointestinal System Bleeding

Background: Risk scores and shock index used in upper gastrointestinal system (GSB) bleeding have an important place in determining the treatment and clinical course of the patient. The aim of this study is to evaluate the predicted success in mortality by analyzing shock indices together with Glasgow Blatchford Scoring (GBS) and Rockall Scoring (RS), whichare used in upper GI bleeding. Methods: This study was conducted with a retrospective analysis of patients who were hospitalized with a diagnosis of upper GI bleeding from the emergency department of a single-center secondary care health institution. For each patient, age, gender, treatment procedures performed in the emergency department or clinic, and endoscopy results were evaluated. Mortality and discharge status of the patients were compared with the scoring values. Result: 86 patients were evaluated in the study. The average age was 69.09±19.07 and the most applications were in the 61-79 age range (48.8%). The most common presenting complaints of the patients were bloody vomiting and black stools. On physical examination, melena was positive in 64% of the patients. 89.5% of the patients were treated in intensive care. The mortality rate was 10.5%. In patients with death, the shock index value was ≥0.75 in all patients and the average was 1.07. As a result of the study, it was seen that GBS, RS and shock index were successful in predicting mortality. Conclusion: Current scoring systems need to be developed in order to manage patients with upper GI bleeding, which is frequently seen in emergency departments today, more quickly and to reduce patient costs.

Shock Index and Modified Shock Index Are Predictors of Long-Term Mortality in STEMI and NSTEMI Patients

Background: Acute coronary syndromes (ACS), including STEMI and NSTEMI, are leading causes of mortality worldwide. The Shock Index (SI) and Modified Shock Index (MSI) are non-invasive markers traditionally used to assess hemodynamic status but their role in predicting long-term mortality in ACS patients is less understood. Objective: To evaluate the prognostic value of SI and MSI in predicting long-term mortality among patients with STEMI and NSTEMI. Methods: A prospective cohort study was conducted on 275 consecutive patients diagnosed with STEMI and NSTEMI at the Department of Cardiology, PIMS, Islamabad, between March 1, 2024, and July 31, 2024. Patients were divided into two groups: Group 1 (n=138) assessed using SI and Group 2 (n=137) using MSI. Follow-up for three years was conducted to record all-cause mortality. Data were analyzed using SPSS version 25.0, with Cox proportional hazards regression and Kaplan-Meier survival analysis employed to assess mortality risk. Results: During the three-year follow-up, mortality rates were 24.6% in the SI group and 26.3% in the MSI group. Higher SI and MSI values were significantly associated with increased mortality (SI HR=1.85, 95% CI: 1.35-2.54, p<0.001; MSI HR=2.10, 95% CI: 1.50-2.93, p<0.001). Conclusion: SI and MSI are significant predictors of long-term mortality in STEMI and NSTEMI patients and should be integrated into routine clinical assessments for better risk stratification.

Evaluating the Shock Index, Revised Assessment of Bleeding and Transfusion (RABT), Assessment of Blood Consumption (ABC) and novel PTTrauma score to predict critical transfusion threshold (CAT) in penetrating thoracic trauma

The shock index (SI) has been associated with predicting transfusion needs in trauma patients. However, its utility in penetrating thoracic trauma (PTTrauma) for predicting the Critical Administration Threshold (CAT) has not been well-studied. This study aimed to evaluate the prognostic value of SI in predicting CAT in PTTrauma patients and compare its performance with the Assessment of Blood Consumption (ABC) and Revised Assessment of Bleeding and Transfusion (RABT) scores. We conducted a prognostic type 2, single-center retrospective observational cohort study on patients with PTTrauma and an Injury Severity Score (ISS) > 9. The primary exposure was SI at admission, and the primary outcome was CAT. Logistic regression and decision curve analysis were used to assess the predictive performance of SI and the PTTrauma score, a novel model incorporating clinical variables. Of the 620 participants, 53 (8.5%) had more than one CAT. An SI > 0.9 was associated with CAT (adjusted OR 4.89, 95% CI 1.64–14.60). The PTTrauma score outperformed SI, ABC, and RABT scores in predicting CAT (AUC 0.867, 95% CI 0.826–0.908). SI is a valuable predictor of CAT in PTTrauma patients. The novel PTTrauma score demonstrates superior performance compared to existing scores, highlighting the importance of developing targeted predictive models for specific injury patterns. These findings can guide clinical decision-making and resource allocation in the management of PTTrauma.

Use of Shock Index, Modified Shock Index, and Age-Adjusted Shock Index for Detection of Postpartum Hemorrhage.

The aim of this study is to evaluate the role of shock index (SI), modified shock index (MSI), and delta shock index (ΔSI) in predicting postpartum hemorrhage (PPH) and adverse maternal outcomes. In this cross-sectional cohort study, a study group consisting of 416 pregnant women who delivered at our hospital and had postpartum hemorrhage was compared with 467 control patients with normal follow-up. SI (pulse/systolic blood pressure), MSI (pulse/mean arterial pressure), ΔSI (input SI - 2nd- or 6th-hour SI) values were calculated. A total of 883 postpartum women were included in the study. The study group had higher peripartum, 2nd-hour, and 6th-hour SI values (p=0.011, p=0.001, p<0.001, respectively). Peripartum MSI values (p=0.004), 2nd-hour MSI values (p<0.001), and 6th-hour MSI values (p<0.001) were significantly lower in the control group than in the PPH group. When the groups were evaluated, the cut-off value of the 2nd-hour SI parameter was>0.8909 (sensitivity 30%, specificity 84%), and the 6th-hour SI parameter was>0.8909 (sensitivity 40%, specificity 80%) for predicting postpartum hemorrhage requiring blood transfusion and surgical intervention. The cut-off value of the 2nd-hour MSI parameter was>1.2 (sensitivity 34%, specificity 82%), and the cut-off value of the 6th-hour MSI parameter was>1.2652 (sensitivity 32%, specificity 90%). The 2nd- and 6th-hour SI and 2nd- and 6th-hour MSI values were significantly higher in patients with postpartum hemorrhage. Values greater than 0.89 for SI and 1.2 for MSI were considered significant for predicting postpartum hemorrhage with maternal impairment.

Retrospective evaluation of the utility of shock index to determine the presence of congestive heart failure in dogs with myxomatous mitral valve disease (2019-2021): 98 cases.

To calculate the shock index (SI) in dogs with myxomatous mitral valve disease (MMVD) and to evaluate its use to predict the presence of congestive heart failure (CHF). Retrospective study. Small animal university veterinary teaching hospital. Ninety-eight dogs with MMVD and 20 healthy dogs as part of a control group. Heart rate (HR) and systolic blood pressure (SBP) were recorded, and SI was calculated by dividing HR by SBP for each dog. The mean (SD) HR, SBP, and SI were 123/min (32.6), 147mmHg (21.5), and 0.86 (0.3), respectively, for dogs with MMVD and 98/min (20.9), 145mmHg (18.7), and 0.68 (0.13), respectively, for control dogs. Dogs with MMVD had a significantly higher HR compared with control dogs (P<0.01), and an elevation in HR was seen as the severity of MMVD increased. Dogs in stage B2 and C/D MMVD had a significantly higher SI value compared with control dogs (P=0.04 and P<0.01, respectively). SI was significantly higher in dogs in stage C/D MMVD compared with dogs in stage B2 MMVD (P<0.01). Ten of 98 (10%) dogs had an arrhythmia. HR, SBP, and SI were not significantly different between dogs with and without arrhythmias (P=0.13, P=0.57, and P=0.07, respectively), but significantly more dogs with CHF had an arrhythmia (P=0.01). SI (area under the curve [AUC]: 0.98) and HR (AUC: 0.95) were excellent indicators for the presence of CHF. An optimal SI cutoff value ≥1.1 had 92% sensitivity and 95% specificity for predicting the presence of CHF, and an optimal HR cutoff value of ≥157/min had 92% sensitivity and 93% specificity for the prediction of CHF. When there are compatible clinical signs, SI values ≥1.1 may suggest the presence of CHF in dogs with MMVD.

Shock Index is a Stronger Predictor of Outcomes in Older Compared to Younger Patients

IntroductionThe shock index (SI) is a known predictor of unfavorable outcomes in trauma. This study seeks to examine and compare the SI values between geriatric patients and younger adults. MethodsWe conducted a retrospective study of the Trauma Quality Improvement Program database from 2017 to 2019. All patients≥ 25 y with injury severity score ≥ 16 were included. Age groups were defined as 25-44 y (group A), 45-64 y (group B), and ≥65 y (group C). SI was calculated for all patients. The primary outcome was mortality and secondary outcomes were need for blood transfusion and need for major surgical intervention (consisting angiography, exploratory laparotomy, and thoracotomy). ResultsA total of 244,943 patients were studied. The SI was highest in group A (0.82 ± 0.33) and lowest in group C (0.62 ± 0.30) (P < 0.001). Mortality rate of group C (17%) was significantly higher than group A (9.7%) and B (11.3%) (P < 0.001). In group A, each 0.1 increase in SI was associated with mortality (odds ratio [OR] = 1.079), need for blood transfusion (OR = 1.225) and need for major surgical intervention (OR = 1.347) (P < 0.001 for all). In group C, each 0.1 increase in SI was associated with mortality (OR = 1.126), need for blood transfusion (OR = 1.318), and need for major surgical intervention (OR = 1.648) (P < 0.001 for all). The area under the curve of SI was significantly higher in group C compared to other groups for needing a major surgical intervention and need for blood transfusion (P < 0.05 for both). ConclusionsThese results highlight the significance of the SI as a valuable indicator in geriatric patients with severe trauma. The findings show that SI predicts outcomes in geriatrics more strongly than in younger counterparts.

BASELINE SHOCK INDEX–CREATININE CLEARANCE AS A PREDICTOR OF LONG–TERM MORTALITY AFTER ACS. RESULTS FROM 24 YEARS OF FOLLOW–UP OF THE ABC STUDY ON HEART DISEASE

Abstract Background Shock index (SI), defined as heart rate divided by systolic blood pressure, is a useful simple predictor of long–term mortality after acute myocardial infarction. Purpose To assess the utilization of the SI updated version that includes renal function (Shock Index–Creatinine Clearance (SI–C)) to predict long–term mortality after ACS. Methods This preliminary analysis included 589 patients with ACS admitted to three Italian hospitals and discharged alive. Baseline clinical and laboratory data were collected within the first 7 days of hospitalization and SI–C was calculated as (SI×100)–estimated CCr. Patients were prospectively followed for 24 years or until death. Results Virtually all patients completed the follow–up, representing 7066 person–years. Patients‘ mean age was 66±12 years, 70% were males and 482(82%) had died during follow–up. Compared to those who survived, deceased patients were significantly different in many clinical features. They also showed significantly higher SI–C values ( –11± 25 vs. –36±23, p&amp;lt;0.0001). The predictive value of SI–C for 24–year mortality was very good (area under the curve= 0.783, 95% CI: 0.738–0.827, p&amp;lt;0.001). The cumulative risk was significantly higher in the upper SI–C tertile (log–rank = 162.1, p &amp;lt; 0.001). Unadjusted Cox regression survival analysis showed that the SI–C score was significantly associated with long–term global mortality (HR: 2.1, 95%CI 1.8–2.3, p&amp;lt;0.0001). A fully adjusted model revealed the same results. Conclusion Baseline SI–C seems to be an effective independent predictor of long–term global mortality after ACS. It may have potential as a novel and simple early risk stratification tool for ACS patients including long–term outcomes.

Optimizing Triage: Assessing Shock Index, Pediatric Age-Adjusted as an Adjunct to Improve Emergency Severity Index Mistriage.

We investigated the diagnostic value of shock index, pediatric age-adjusted (SIPA) in predicting Emergency Severity Index level 3 patients' outcomes. Secondary objectives included exploring the impact of fever and participant variables on SIPA's predictive ability. A retrospective chart review identified children aged 1 to 15 years triaged as a level 3 in the emergency department between January 2018 and December 2021. Shock index, pediatric age-adjusted thresholds based on age, 1 to 6 years (>1.2), 7 to 12 years (>1.0), and 13 to 17 years (>0.9), were used. We assessed elevated SIPA and SIPA corrected for fever to evaluate associations with outcomes and interventions. Our findings, involving 192 patients, revealed that elevated SIPA demonstrated enhanced discrimination relative to nonelevated SIPA. Patients with elevated SIPA had more average interventions: 1.14 versus 0.74, P < 0.016; average interventions using SIPA corrected for fever: 1.14 versus 0.77, P < 0.006; average interventions controlling for race and sex: 1.15 versus 0.71, P < 0.001; hospital admission: 64.4% versus 42.9%, P = 0.004; hospital length of stay (LOS): 3.06 days (SE, 0.42) versus 1.46 days (SE, 0.23); hospital LOS using SIPA corrected for fever: 2.75 days (SE, 0.44) versus 1.72 days (SE, 0.24); ventilatory support: 16.44% versus 3.36%, P < 0.002; fluid bolus: 28.77% versus 14.29%, P < 0.015; intravenous medications (antibiotics, antiepileptics, immune globulin, albumin): 45.21% versus 30.25%, P < 0.036. There was no difference between other interventions, pediatric intensive care admission, and LOS between the 2 groups. Importantly, SIPA was unaffected by fever, race, or sex. Shock index, pediatric age-adjusted identifies level 3 Emergency Severity Index pediatric patients more likely to require hospital admission, longer LOS, and a lifesaving intervention especially ventilatory support, intravenous fluids, or specific intravenous medications. Shock index, pediatric age-adjusted's predictive ability remained unaffected by fever, race, or sex, making it a valuable tool in preventing mistriage and justifying inclusion in the Emergency Severity Index danger zone vitals criteria for up-triage.

Centiles for the shock index among injured children in the prehospital setting

ObjectiveThe shock index (SI), the ratio of heart rate to systolic blood pressure, is a clinical tool for assessing injury severity. Age-adjusted SI models may improve predictive value for injured children in the out-of-hospital setting. We sought to characterize the proportion of children in the prehospital setting with an abnormal SI using established criteria, describe the age-based distribution of SI among injured children, and determine prehospital interventions by SI. MethodsWe performed a multi-agency retrospective cross-sectional study of children (<18 years) in the prehospital setting with a scene encounter for suspected trauma and transported to the hospital between 2018 and 2022 using the National Emergency Medical Services (EMS) Information System datasets. Our exposure of interest was the first calculated SI. We identified the proportion of children with an abnormal SI when using the SI, pediatric age-adjusted (SIPA); and the pediatric SI (PSI) criteria. We developed and internally validated an age-based distributional model for the SI using generalized additive models for location, scale, and shape to describe the age-based distribution of the SI as a centile or Z-score. We evaluated EMS interventions (basic airway interventions, advanced airway interventions, cardiac interventions, vascular access, intravenous fluids, and vasopressor use) in relation to both the SIPA, PSI, and distributional SI values. ResultsWe analyzed 1,007,863 pediatric EMS trauma encounters (55.0% male, median age 13 years [IQR, 8–16 years]). The most common dispatch complaint was for traffic/transport related injury (32.9%). When using the PSI and SIPA, 13.1% and 16.3% were classified as having an abnormal SI, respectively. There were broad differences in the percentage of encounters classified as having an abnormal SI across the age range, varying from 5.1 to 22.8% for SIPA and 3.7–20.1% for PSI. The SIPA values ranged from the 75th to 95th centiles, while the PSI corresponded to an SI greater than the 90th centile, except in older children. The centile distribution for SI declined during early childhood and stabilized during adolescence and demonstrated a difference of <0.1% at cutoff values. An abnormal PSI, SIPA and higher SI centiles (>90th centile and >95th centiles) were associated with interventions related to basic and advanced airway management, cardiac procedures, vascular access, and provision of intravenous fluids occurred with greater frequency at higher SI centiles. Some procedures, including airway management and vascular access, had a smaller peak at lower (<10th) centiles. DiscussionWe describe the empiric distribution of the pediatric SI across the age range, which may overcome limitations of extant criteria in identifying patients with shock in the prehospital setting. Both high and low SI values were associated with important, potentially lifesaving EMS interventions. Future work may allow for more precise identification of children with significant injury using cutpoint analysis paired to outcome-based criteria. These may additionally be combined with other physiologic and mechanistic criteria to assist in triage decisions.

Shock Index as a Predictor of Mortality and Hospital Admission in Prehospital Gastrointestinal Bleeding: A Retrospective Cohort Study

Objective To evaluate the Shock Index (SI) as a predictive tool for triage of gastrointestinal bleeding (GI) in the prehospital setting, assessing its correlation with mortality, admission rates, and hospital length of stay. Methods In this retrospective cohort study, we analyzed data from the ESO Data Collaborative encompassing EMS records from the year 2022, focusing on 1525 patients with a primary GI bleeding diagnosis. The primary measure was the SI, calculated at initial contact and highest recorded prior to ED arrival. Statistical analysis included t-tests, linear regression, and ROC curves, performed using SPSS v29. Results A significantly higher mean SI was observed in patients who died (mean SI 0.997) compared to survivors (mean SI 0.795), p < 0.001. Admission rates also correlated with higher SI values, p < 0.001. However, SI was not predictive of the hospital length of stay. ROC analysis for mortality prediction yielded an AUC of 0.656 for the initial SI and 0.739 for the highest SI. The standard SI cutoff of 0.9 predicted mortality with a sensitivity of 74.14% and specificity of 55.35% for the highest SI. Conclusion The SI is a valuable predictive tool for mortality among prehospital patients with GI bleeding. Its application may improve the triage process, potentially influencing transport decisions and initial hospital care. Despite its predictive capability for mortality, the SI should be supplemented with other clinical assessments to make comprehensive prehospital care decisions. Further research into SI as part of a comprehensive assessment which includes end-title CO2, mentation, and heaviness of bleeding.

Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction.

The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%). Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels. The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.

Evaluation of postpartum shock index in hypertensive diseases of pregnancy: acase-control study from a tertiary reference center.

To compare the postpartum shock index (SI) values between pregnant women with hypertensive disease of pregnancy (HDP) and normotensive controls. The present study was conducted in Ankara City Hospital Perinatology Clinic. Postpartum SI was compared between the pregnant women with HDP (n=217) and normotensive controls (n=219). A logistic regression analysis was performed to assess the independent predictors of maximum SI≥1. Finally, a ROC analysis was performed to calculate optimal cut-off values for postpartum SI's measured at different periods in the prediction of postpartum Hb (hemoglobin) decrease≥2 g/dL. Peripartum SI (p<0.001), 15th min SI (p<0.001), 30th min SI (p<0.001), 2nd h SI (p<0.001), 6th h SI (p)of the HDP group (p<0.001) and max SI (p<0.001) values were found to be significantly lower in the study group. A weak positive and statistically significant correlation was found between the maximum SI and the decrease in Hb≥2 g/dL (r=0.209; p=0.002). Optimal cutoff values for SI were; 0.7 at peripartum 0.7 at 15 min, 0.73 at 30 min, 0.6 at 2 h, and 0.7 at 6 h, respectively. Clinically significant blood loss may develop at lower SI values in hypertensive pregnant women.

Shock and modified shock indices in predicting poisoning severity and outcomes in acute aluminum phosphide poisoned patients.

Severe refractory hypotension and cardiogenic shock are the main contributors to death in acute aluminum phosphide (ALP) poisoning. Shock index (SI) and modified shock index (MSI) are easily obtained parameters that reflect shock at an early stage. This study aimed to evaluate the role of SI and MSI in the prediction of the severity and outcomes of acute ALP poisoned patients. This cross sectional study was conducted on patients admitted to Tanta University Poison Control Centre with acute ALP poisoning from April 2022 to March 2023. Socio-demographics and toxicological data were taken, findings of clinical examination and laboratory investigations were recoded, SI was calculated by dividing heart rate over systolic blood pressure, and MSI was obtained by dividing heart rate over mean arterial pressure. Poisoning severity was assessed using poisoning severity score (PSS). Patients were divided into groups according to intensive care unit (ICU) admission and mortality. The study enrolled 94 patients. The median values of SI and MSI were significantly higher in ICU-admitted patients and non-survivors rather than their comparable groups. Significant positive correlations were observed between each of SI and MSI and PSS. At cut-off >1.14, SI conveyed fair performance to predict ICU admission and mortality (AUC=0.710 and 0.739, respectively). Similarly, MSI had fair performance to predict ICU admission (AUC=0.731) and mortality (AUC=0.744) at cut-off >1.47 and >1.5, respectively. Both SI and MSI could be considered simple bedside adjuncts to predict ICU admission and mortality in acute ALP poisoning.

PREDICTING IN-HOSPITAL MORTALITY AFTER BLUNT THORACO-ABDOMINAL TRAUMATIC INJURY USING SHOCK INDEX

Assessing the usefulness of the Shock Index (SI) in isolated blunt torso (thoraco-abdominal) trauma and its effects on resuscitation and predicting mortality is crucial. In this prospective observational study conducted at Ruth K.M. Pfau Civil Hospital, Karachi, individuals aged 16 years or older presenting with isolated thoraco-abdominal trauma were studied. Basic clinical assessments, including the measurement of SI, were carried out, and patients were resuscitated according to protocol. Another set of vitals was taken three hours after resuscitation. Patient progress in the hospital was followed until death or discharge. Both values of SI and DSI were plotted against the patient's outcome. The results showed that values of SI remained elevated even after three hours of resuscitation in the non-survivors group of trauma patients. Furthermore, rates of ICU admissions and surgical interventions were also high among non-survivors. Therefore, this study concludes that SI is an essential factor in predicting mortality in blunt thoraco-abdominal traumatic injuries.

RELATIONSHIP BETWEEN SHOCK INDEX, MODIFIED SHOCK INDEX, AND AGE SHOCK INDEX AND 28-DAY MORTALITY AMONG PATIENTS WITH PREHOSPITAL SEPTIC SHOCK

BackgroundA relative hypovolemia occurs during septic shock (SS); the early phase is clinically reflected by tachycardia and low blood pressure. In the prehospital setting, simple objective tools to assess hypovolemia severity are needed to optimize triaging. ObjectiveThe aim of this study was to evaluate the relationship between shock index (SI), diastolic SI (DSI), modified SI (MSI), and age SI (ASI) and 28-day mortality of patients with SS initially cared for in a prehospital setting of a mobile intensive care unit (MICU). MethodsFrom April 6, 2016 through December 31, 2021, 530 patients with SS cared for at a prehospital MICU were analyzed retrospectively. Initial SI, MSI, DSI, and ASI values, that is, first measurement after MICU arrival to the scene were calculated. A propensity score analysis with inverse probability of treatment weighting (IPTW) method was used to assess the relationship between SI, DSI, MSI, and ASI and 28-day mortality. ResultsSS resulted mainly from pulmonary, digestive, and urinary infections in 44%, 25%, and 17% of patients. The 28-day overall mortality was 31%. IPTW propensity score analysis indicated a significant relationship between 28-day mortality and SI (adjusted odds ratio [aOR] 1.13; 95% CI 1.01–1.26; p = 0.04), DSI (aOR 1.16; 95% CI 1.06–1.34; p = 0.03), MSI (aOR 1.03; 95% CI 1.01–1.17; p = 0.03), and ASI (aOR 3.62; 95% CI 2.63–5.38; p < 10–6). ConclusionsSI, DSI, MSI, and ASI were significantly associated with 28-day mortality among patients with SS cared for at a prehospital MICU. Further studies are needed to confirm the usefulness of SI and SI derivates for prehospital SS optimal triaging.

The Predictive Value of Shock Index in Rural Trauma Triage, Morbidity, and Mortality.

The Predictive Value of Shock Index in Rural Trauma Triage, Morbidity, and Mortality.

Predictive values of age shock index and age modified shock index for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Abstract Background and Purpose This study aimed to evaluate the predictive values of admission age shock index (age SI) and age modified shock index (age MSI) for short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Methods 7324 patients with STEMI were included in the present study. Shock index (SI), modified shock index (MSI), age SI, age MSI and the TIMI score were calculated on admission. The primary outcome was all-cause mortality and the secondary outcomes were recurrent MI, cardiogenic shock and major adverse cardiovascular events (MACEs) during 30-day follow-up. Univariate and multivariate Cox regression were performed to evaluate the association between age SI, age MSI and outcomes. Predictive values of SI, MSI, age SI, age MSI and the TIMI score were evaluated and compared through analysis of the receiver operating characteristic (ROC) curves and integrated discrimination improvement (IDI). Results According to the ROC curve, the best cutoff of age SI for 30-day all-cause mortality were 50.0. Patients with elevated age SI had more comorbidities, received less evidence-based treatments and carried worse 30-day mortality. Multivariate Cox regressions demonstrated that age SI and age MSI were independent predictors of 30-day all-cause mortality and MACEs. The predictive values of age MSI for 30-day mortality were comparable to that of the TIMI score (c statistic: 0.743 vs. 0.758, z=1.740, p=0.082; IDI: 0.011, p=0.055) and better than that of SI (c statistic: 0.743 vs. 0.660, z=14.317, p&amp;lt;0.001; IDI: 0.046, p&amp;lt;0.001). The prognostic performance of age MSI was slightly inferior to that of the TIMI score (c statistic: 0.741 vs. 0.758, z=2.060, p=0.039; IDI: -0.001, p=0.846). Conclusion Age SI and age MSI were independent predictors for 30-day all-cause mortality and MACEs in patients with STEMI. The predictive value of age SI was comparable with the TIMI score but better than SI. Age SI and age MSI are practical risk stratification tools for STEMI.Figure.Receiver operating characterisTable.Discrimination and Calibration

The value of shock index, modified shock index and age shock index to predict mortality and hospitalisation in a district level emergency centre

IntroductionTriage is the most important step in patients’ journey through an Emergency Centre (EC) and directly impacts time to critical actions. Triage tools, like the South African Triage Scale, are however not designed to predict patient outcomes. The shock index (SI), modified shock index (MSI) and age shock index (ASI) are clinical markers derived from vital signs and correlate with tissue perfusion in critically ill patients. This study aimed to assess the value of SI, MSI and ASI to predict mortality and the need for hospitalisation in all adult patients presenting to a district level emergency centre in South Africa. MethodsThis diagnostic study was performed as a retrospective observational study, using data from an existing electronic registry at a district level hospital emergency centre over a period of 24 months. All adult patients who presented to Mitchells Plain Hospital were eligible for inclusion. Sensitivity, specificity and likelihood ratios were calculated for each variable as a predictor of mortality and hospitalisation with pre-determined thresholds. ResultsDuring the study period of 24 months, a total of 61 329 patients ≥ 18 years old presented to the EC with 60 599 included in the final sample. A red SATS triage category (+LR = 7.2) and SI ≥1.3 (+LR = 4.9) were the only two predictors with any significant clinical value. The same two markers performed well for both patients with and without trauma and specifically for patients who died while under the care of the emergency centre. DiscussionThe study demonstrated that patients with a SI≥1.3 at triage have a significantly higher likelihood to die or require hospitalisation, whether the presenting complaint is trauma related or not, especially to predict mortality while under the care of the EC. Incorporating this marker as a triage alert could expedite the identification of patients requiring time critical interventions and improve patient throughput in the emergency centre.