Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury

Wan-Ting, Chu; Chin-Hsien, Liao; Cheng-Yu, Lin; Chien, Cheng-Yu; Cc, Lin; Keng-Wei, Chang; Chen, Jiann-Hwa; Chen, Wei-Lung; Chien-Cheng, Huang; Lim, Cherng-Jyr; Chung, Jui-Yuan

doi:10.1038/s41598-020-59044-w

Cited by 27 publications

(37 citation statements)

References 30 publications

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“…7 A new scoring tool, rSIG, which is defined as the reverse shock index (the SBP divided by HR) multiplied by the Glasgow Coma Scale (GCS) score, has been shown to be more predictive of in-hospital mortality than standard scoring systems, including SI, among adult patients. [8][9][10] Reverse shock index multiplied by Glasgow Coma Scale has recently been shown to be more predictive of mortality than SIPA in both military and civilian settings. 11,12 This suggests that rSIG may be more generalizable than SIPA to pediatric trauma patients regardless of injury mechanism; however, its full utility is unstudied in the pediatric population.…”

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confidence: 99%

Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale

Reppucci

Acker

Cooper

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:The shock index pediatric age-adjusted (SIPA) predicts the need for increased resources and mortality among pediatric trauma patients without incorporating neurological status. A new scoring tool, rSIG, which is the reverse shock index (rSI) multiplied by the Glasgow Coma Scale (GCS), has been proven superior at predicting outcomes in adult trauma patients and mortality in pediatric patients compared with traditional scoring systems. We sought to compare the accuracy of rSIG to Shock Index (SI) and SIPA in predicting the need for early interventions in civilian pediatric trauma patients. METHODS:Patients (aged 1-18 years) in the 2014 to 2018 Pediatric Trauma Quality Improvement Program database with complete heart rate, systolic blood pressure, and total GCS were included. Optimal cut points of rSIG were calculated for predicting blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. From the optimal thresholds, sensitivity, specificity, and area under the curve were calculated from receiver operating characteristics analyses to predict each outcome and compared with SI and SIPA. RESULTS:A total of 604,931 patients with a mean age of 11.1 years old were included. A minority of patients had a penetrating injury mechanism (5.6%) and the mean Injury Severity Score was 7.6. The mean SI and rSIG scores were 0.85 and 18.6, respectively. Reverse shock index multiplied by Glasgow Coma Scale performed better than SI and SIPA at predicting early trauma outcomes for the overall population, regardless of age. CONCLUSION:Reverse shock index multiplied by Glasgow Coma Scale outperformed SI and SIPA in the early identification of traumatically injured children at risk for early interventions, such as blood transfusion within 4 hours, intubation, intracranial pressure monitoring, and intensive care unit admission. Reverse shock index multiplied by Glasgow Coma Scale adds neurological status in initial patient assessment and may be used as a bedside triage tool to rapidly identify pediatric patients who will likely require early intervention and higher levels of care.

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confidence: 99%

Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale

Reppucci

Acker

Cooper

et al. 2021

J Trauma Acute Care Surg

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“…Several studies have demonstrated that the GCS score was related to the mortality of patients with TBI [3,22]. In a study by Han et al, a GCS score of ≤5 was associated with mortality in most groups, and the GCS score of non-survivors was 4 (3)(4)(5)(6)(7)(8)(9) in this study [22]. In another study on patients with TBI, the OR of the GCS score for mortality was 0.765, similar to that obtained in the present study [3], in which the GCS score of nonsurvivors corresponded to the unresponsiveness parameter in the AVPU scale [23].…”

Section: Discussionmentioning

confidence: 99%

“…Several triage tools for TBI have been developed, and studies have reported the efficacies of these tools for predicting prognosis [3][4][5][6][7][8]. Among these, the Injury Severity Score (ISS) and Revised Trauma Score (RTS) are the most commonly used tools in severe trauma patients, including those with TBI [3,4].…”

Section: Introductionmentioning

confidence: 99%

“…However, the relationship between these tools and the prognosis of patients with TBI is not well understood, and some studies have even questioned these relationships [9][10][11]. The Shock Index (SI), the ratio of heart rate to systolic blood pressure (SBP), was related to hypovolemic shock in patients with severe trauma, including TBI [5,6], and may be related to the mortality of patients with TBI [7]. In addition, previous studies have reported that early warning scores, such as the Modified Early Warning Score (MEWS), are related to adverse events, including hypotension and the need for advanced airway management, need for intensive care, and early mortality in patients with TBI [8].…”

Section: Introductionmentioning

confidence: 99%

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Performance of Modified Early Warning Score (MEWS) for Predicting In-Hospital Mortality in Traumatic Brain Injury Patients

Kim

Lee

et al. 2021

JCM

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The present study aimed to analyze and compare the prognostic performances of the Revised Trauma Score (RTS), Injury Severity Score (ISS), Shock Index (SI), and Modified Early Warning Score (MEWS) for in-hospital mortality in patients with traumatic brain injury (TBI). This retrospective observational study included severe trauma patients with TBI who visited the emergency department between January 2018 and December 2020. TBI was considered when the Abbreviated Injury Scale was 3 or higher. The primary outcome was in-hospital mortality. In total, 1108 patients were included, and the in-hospital mortality was 183 patients (16.3% of the cohort). Receiver operating characteristic curve analyses were performed for the ISS, RTS, SI, and MEWS with respect to the prediction of in-hospital mortality. The area under the curves (AUCs) of the ISS, RTS, SI, and MEWS were 0.638 (95% confidence interval (CI), 0.603–0.672), 0.742 (95% CI, 0.709–0.772), 0.524 (95% CI, 0.489–0.560), and 0.799 (95% CI, 0.769–0.827), respectively. The AUC of MEWS was significantly different from the AUCs of ISS, RTS, and SI. In multivariate analysis, age (odds ratio (OR), 1.012; 95% CI, 1.000–1.023), the ISS (OR, 1.040; 95% CI, 1.013–1.069), the Glasgow Coma Scale (GCS) score (OR, 0.793; 95% CI, 0.761–0.826), and body temperature (BT) (OR, 0.465; 95% CI, 0.329–0.655) were independently associated with in-hospital mortality after adjustment for confounders. In the present study, the MEWS showed fair performance for predicting in-hospital mortality in patients with TBI. The GCS score and BT seemed to have a significant role in the discrimination ability of the MEWS. The MEWS may be a useful tool for predicting in-hospital mortality in patients with TBI.

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“…Low GCS on arrival, high international normalized ratio (INR), and the need for intubation were all found to be risk factors of in-hospital mortality even though multivariate analysis failed to identify them as independent predictors of death [ 10 , 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Independent Predictors of Mortality in Torso Trauma Injuries

Bini

Accardo

Granieri

et al. 2020

JCM

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Noncompressible torso injuries (NCTIs) represent a trauma-related condition with high lethality. This study’s aim was to identify potential prediction factors of mortality in this group of trauma patients at a Level 1 trauma center in Italy. Materials and Methods: A total of 777 patients who had sustained a noncompressible torso injury (NCTI) and were admitted to the Niguarda Trauma Center in Milan from 2010 to 2019 were included. Of these, 166 patients with a systolic blood pressure (SBP) <90 mmHg were considered to have a noncompressible torso hemorrhage (NCTH). Demographic data, mechanism of trauma, pre-hospital and in-hospital clinical conditions, diagnostic/therapeutic procedures, and survival outcome were retrospectively recorded. Results: Among the 777 patients, 69% were male and 90.2% sustained a blunt trauma with a median age of 43 years. The comparison between survivors and non-survivors pointed out a significantly lower pre-hospital Glasgow coma scale (GCS) and SBP (p < 0.001) in the latter group. The multivariate backward regression model identified age, pre-hospital GCS and injury severity score (ISS) (p < 0.001), pre-hospital SBP (p = 0.03), emergency department SBP (p = 0.039), performance of torso contrast enhanced computed tomography (CeCT) (p = 0.029), and base excess (BE) (p = 0.008) as independent predictors of mortality. Conclusions: Torso trauma patients who were hemodynamically unstable in both pre- and in-hospital phases with impaired GCS and BE had a greater risk of death. The detection of independent predictors of mortality allows for the timely identification of a subgroup of patients whose chances of survival are reduced.

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Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury

Cited by 27 publications

References 30 publications

Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale

Improved identification of severely injured pediatric trauma patients using reverse shock index multiplied by Glasgow Coma Scale

Performance of Modified Early Warning Score (MEWS) for Predicting In-Hospital Mortality in Traumatic Brain Injury Patients

Independent Predictors of Mortality in Torso Trauma Injuries

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