Discriminant ability of the shock index, modified shock index, and reverse shock index multiplied by the Glasgow coma scale on mortality in adult trauma patients: a PATOS retrospective cohort study

Abstract

Background: The shock index (SI) predicts short-term mortality in trauma patients. Other shock indices have been developed to improve discriminant accuracy. The authors examined the discriminant ability of the SI, modified SI (MSI), and reverse SI multiplied by the Glasgow Coma Scale (rSIG) on short-term mortality and functional outcomes. Methods: The authors evaluated a cohort of adult trauma patients transported to emergency departments. The first vital signs were used to calculate the SI, MSI, and rSIG. The areas under the receiver operating characteristic curves and test results were used to compare the discriminant performance of the indices on short-term mortality and poor functional outcomes. A subgroup analysis of geriatric patients with traumatic brain injury, penetrating injury, and nonpenetrating injury was performed. Results: A total of 105 641 patients (49±20 years, 62% male) met the inclusion criteria. The rSIG had the highest areas under the receiver operating characteristic curve for short-term mortality (0.800, CI: 0.791–0.809) and poor functional outcome (0.596, CI: 0.590–0.602). The cutoff for rSIG was 18 for short-term mortality and poor functional outcomes with sensitivities of 0.668 and 0.371 and specificities of 0.805 and 0.813, respectively. The positive predictive values were 9.57% and 22.31%, and the negative predictive values were 98.74% and 89.97%. rSIG also had better discriminant ability in geriatrics, traumatic brain injury, and nonpenetrating injury. Conclusion: The rSIG with a cutoff of 18 was accurate for short-term mortality in Asian adult trauma patients. Moreover, rSIG discriminates poor functional outcomes better than the commonly used SI and MSI.

Cutoff of the reverse shock index multiplied by the Glasgow coma scale for predicting in-hospital mortality in adult patients with trauma: a retrospective cohort study

“…In their study, the mean rSIG value for the study group was 23.80 ± 8.17, and they proposed a cutoff of 18. These values closely resemble those observed in our study [ 14 ]. Our study aimed to propose an rSIG cutoff point to identify patients with trauma with the potential risk of death at the scene.…”

“…However, to utilize continuous variables such as rSIG as a screening tool for identifying severe trauma patients, establishing a reliable cutoff is essential. Previous studies have proposed cutoff values of 10.20, 14, and 18 for rSIG to predict in-hospital mortality in trauma [ 11 , 13 , 14 ]. This substantial differences among the previously proposed cutoffs necessitates additional research to refine them.…”

Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19

“…The GCS is commonly used to evaluate a patient’s level of consciousness and is a stronger predictor of mortality than SBP, respiratory rate (RR), and age [ 29 , 30 ]. The rSI-GCS is a useful and accurate triage tool for detecting hypovolemic shock and can also be used to predict the need for massive blood transfusion, coagulopathy, in-hospital mortality, and 24-h mortality in patients with trauma [ 7 , 8 , 10 , 31 – 36 ]. However, utilizing the GCS during prehospital triage is a time-consuming process.…”

Prehospital Lactate Levels Obtained in the Ambulance and Prediction of 2-Day In-Hospital Mortality in Patients With Traumatic Brain Injury

“…The shock index was calculated as the ratio of heart rate to systolic blood pressure and is an indicator of occult shock, especially in patients with trauma or acute bleeding. 18…”