Usefulness of the Shock Index as a secondary triage tool

Vassallo, James; Horne, Simon; Ball, Susan; Smith, Jessi L.

doi:10.1136/jramc-2013-000178

Cited by 15 publications

(18 citation statements)

References 25 publications

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“…Its predicting value for the outcome has been fully demonstrated in the patients with trauma [1][2][3][4]. Recently, some studies further showed that a new index, MSI, in the ED is a more valuable marker for predicting the mortality rate than SI alone in adult patients with trauma [14].…”

Section: Discussionmentioning

confidence: 97%

“…It has been demonstrated as a useful predictor for hospital mortality among adult patients with trauma [1][2][3]. Shock index is better not only than SBP, diastolic blood pressure (DBP), and HR alone but also than some risk stratification systems, for example, SI is more useful than the Triage Sort (TSO) for secondary triage in a mass-casualty situation [4].…”

Section: Introductionmentioning

confidence: 99%

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Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shangguan

et al. 2015

The American Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Shangguan

et al. 2015

The American Journal of Emergency Medicine

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“…Clinical assessment and standard coagulation assays are still the most commonly used tools in this context according to the literature [15,16] and, therefore, still play a major role in level I trauma centres as shown here. The Shock Index (SI) defined by the ratio of heart rate to systolic blood pressure has recently been advocated as a clinical indicator of hypovolaemic shock in respect to transfusion requirement, haemostatic resuscitation and outcome [21][22][23][24].…”

Section: Discussionmentioning

confidence: 99%

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

Driessen

Schäfer²,

Albrecht

et al. 2014

Eur J Trauma Emerg Surg

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“…Once within the casualty clearing station or other permissive environment, secondary triage can occur, allowing for refinement of the triage process and a reduction in patients overtriaged. The Triage Sort as it exists currently shows limited performance for predicting the need for life-saving intervention19; we speculate that future work may be required in order to refine the Triage Sort, and support the consideration of including an assessment of anatomical injury, mechanism of injury and clinical acumen.…”

Section: Discussionmentioning

confidence: 93%

The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage

Vassallo

Horne

Smith³

et al. 2017

J R Army Med Corps

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IntroductionTriage is a key principle in the effective management of major incidents. There is limited evidence to support existing triage tools, with a number of studies demonstrating poor performance at predicting the need for a life-saving intervention. The Modified Physiological Triage Tool (MPTT) is a novel triage tool derived using logistic regression, and in retrospective data sets has shown optimum performance at predicting the need for life-saving intervention.Materials and methodsPhysiological data and interventions were prospectively collected for consecutive adult patients with trauma (>18 years) presenting to the emergency department at Camp Bastion, Afghanistan, between March and September 2011. Patients were considered priority 1 (P1) if they received one or more interventions from a previously defined list. Patients were triaged using existing triage tools and the MPTT. Performance was measured using sensitivity and specificity, and a McNemar test with Bonferroni calculation was applied for tools with similar performance.ResultsThe study population comprised 357 patients, of whom 214 (59.9%) were classed as P1. The MPTT (sensitivity: 83.6%, 95% CI 78.0% to 88.3%; specificity: 51.0%, 95% CI 42.6% to 59.5%) outperformed all existing triage tools at predicting the need for life-saving intervention, with a 19.6% absolute reduction in undertriage compared with the existing Military Sieve. The improvement in undertriage comes at the expense of overtriage; rates of overtriage were 11.6% higher with the MPTT than the Military Sieve. Using a McNemar test, a statistically significant (p<0.001) improvement in overall performance was demonstrated, supporting the use of the MPTT over the Military Sieve.Discussion and conclusionsThe MPTT outperforms all existing triage tools at predicting the need for life-saving intervention, with the lowest rates of undertriage while maintaining acceptable levels of overtriage. Having now been validated on both military and civilian cohorts, we recommend that the major incident community consider adopting the MPTT for the purposes of primary triage.

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Usefulness of the Shock Index as a secondary triage tool

Abstract: RCDM/Res/Audit/1036/12/0050.

Cited by 15 publications

References 25 publications

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Modified Shock Index is a Predictor for 7-Day Outcomes in Patients With STEMI

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

The prospective validation of the Modified Physiological Triage Tool (MPTT): an evidence-based approach to major incident triage

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