Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

Abstract

Background The shock index (SI) is defined as the ratio of heart rate/systolic blood pressure. This study aimed to determine the performance of delta shock index (ΔSI), a difference between SI upon arrival at the emergency room (ER) and that in the field, in predicting the need for massive transfusion (MT) among adult trauma patients with stable blood pressure. Methods This study included registered data from all trauma patients aged 20 years and above who were hospitalized from January 1, 2009 to December 31, 2016. Only patients who were transferred by emergency medical service from the accident site with a systolic blood pressure ≥ 90 mm Hg at the ER were included. The 7,957 enrolled trauma patients were divided into 2 groups, those who had received blood transfusion ≥ 10 U (MT, n = 82) and those who had not (non-MT, n = 7,875). The odds ratios with 95% confidence intervals for the need for MT by a given ΔSI were measured. The plot of specific receiver operating characteristic (ROC) curves was used to evaluate the best cutoff point of ΔSI that could predict the patient’s probability of receiving MT. Results ROC curve analysis showed that a ΔSI of 0.06 as the cutoff point had the highest AUC of 0.61, with a sensitivity of 0.415 and specificity of 0.841. Patients with a ΔSI ≥ 0.00 had a significant 1.8-fold increase in need for MT than those patients with a ΔSI less than 0.00 (1.4% vs. 0.8%, p = 0.01). The larger the ΔSI, the higher the odds of need for an MT. Using the cutoff point of ΔSI of 0.06, patients with a ΔSI ≥ 0.06 had a significant 3.7-fold increase in need for MT than those patients with a ΔSI less than 0.06 (2.7% vs. 0.7%, p < 0.001). Conclusions This study indicated that, in trauma patients with stable blood pressure at the ER, the accuracy of prediction of the requirement for MT by ΔSI is low. However, the size of the delta is significantly associated with need for MT and a lack of improvement in the patient’s SI at the ER compared to that in the field significantly increases the odds of a need for MT.

Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials

“…Instead, hemodynamic factors tend to guide transfusion practices in both trauma and postpartum hemorrhage patients. Studies of blood transfusions in trauma settings suggest that patients with elevated blood pressures and normal heart rates are less likely to receive blood transfusions, including massive transfusions (greater than or equal to ten units of blood) [33,34]. This finding is influenced by the fact that, in settings of acute trauma, decisions to transfuse are often driven by the use of scoring systems like the shock index (defined as heart rate divided by systolic blood pressure).…”

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

“…The exclusion criteria included patients who were transferred from other hospitals or who arrived by private vehicles, patients who had missing SBP or HR data, patients younger than 15 years old, patients who had incomplete registered data, and those who had burn injuries or trauma due to hanging ( Fig. 1) [12,14].…”

“…However, it has been questioned whether SBP and HR are reliable in geriatric trauma patients [6]. Early recognition of the need for MT is important but still presents a challenge in trauma patients [12].…”

The Impact of Age and Receipt Antihypertensives to Systolic Blood Pressure and Shock Index at Injury Scene and in the Emergency Department to Predict Massive Transfusion in Trauma Patients

“…The exclusion criteria included patients who were transferred from other hospitals or using private vehicles, patients who had missing SBP or HR data, patients younger than 15 years old, patients who had incomplete registered data, and those who had burn injuries or trauma due to hanging ( Fig. 1) [12,14].…”

“…However, it has been questioned whether SBP and HR are reliable for assessing geriatric trauma patients [6]. Early recognition of the need for MT is important but still presents a challenge in trauma patients [12].…”