Identifying Risk for Massive Transfusion in the Relatively Normotensive Patient: Utility of the Prehospital Shock Index
Top Cited Papers
- 1 February 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Journal of Trauma and Acute Care Surgery
- Vol. 70 (2), 384-390
- https://doi.org/10.1097/ta.0b013e3182095a0a
Abstract
Background: In the prehospital environment, the failure of medical providers to recognize latent physiologic derangement in patients with compensated shock may risk undertriage. We hypothesized that the shock index (SI; heart rate divided by systolic blood pressure [SBP]), when used in the prehospital setting, could facilitate the identification of such patients. The objective of this study was to assess the association between the prehospital SI and the risk of massive transfusion (MT) in relatively normotensive blunt trauma patients. Methods: Admissions to a Level I trauma center between January 2000 and October 2008 with blunt mechanism of injury and prehospital SBP >90 mm Hg were identified. Patients were categorized by SI, calculated for each patient from prehospital vital signs. Risk ratios (RRs) and 95% confidence intervals (CI) for requiring MT (>10 red blood cell units within 24 hours of admission) were calculated using SI >0.5 to 0.7 (normal range) as the referent for all comparisons. Results: A total of 8,111 patients were identified, of whom 276 (3.4%) received MT. Compared with patients with normal SI, there was no significant increased risk for MT for patients with a SI of ≤0.5 (RR, 1.41; 95% CI, 0.90–2.21) or >0.7 to 0.9 (RR, 1.06; 95% CI, 0.77–1.45). However, a significantly increased risk for MT was observed for patients with SI >0.9. Specifically, patients with SI >0.9 to 1.1 were observed to have a 1.5-fold increased risk for MT (RR, 1.61; 95% CI, 1.13–2.31). Further increases in SI were associated with incrementally higher risks for MT, with an more than fivefold increase in patients with SI >1.1 to 1.3 (RR, 5.57; 95% CI, 3.74–8.30) and an eightfold risk in patients with SI >1.3 (RR, 8.13; 95% CI, 4.60–14.36). Conclusion: Prehospital SI > 0.9 identifies patients at risk for MT who would otherwise be considered relatively normotensive under current prehospital triage protocols. The risk for MT rises substantially with elevation of SI above this level. Further evaluation of SI in the context of trauma system triage protocols is warranted to analyze whether it triage precision might be augmented among blunt trauma patients with SBP >90 mm Hg.Keywords
This publication has 20 references indexed in Scilit:
- Prehospital Hypotension RedefinedThe Journal of Trauma and Acute Care Surgery, 2008
- New Vitals After Injury: Shock Index for the Young and Age × Shock Index for the OldJournal of Surgical Research, 2008
- Heart Rate: Is It Truly a Vital Sign?The Journal of Trauma and Acute Care Surgery, 2007
- POST-TRAUMATIC HYPOTENSIONShock, 2007
- A new predictive scoring system including shock index for unruptured tubal pregnancy patientsEuropean Journal of Obstetrics & Gynecology and Reproductive Biology, 2006
- Shock index in diagnosing early acute hypovolemiaThe American Journal of Emergency Medicine, 2005
- Does tachycardia correlate with hypotension after trauma?Journal of the American College of Surgeons, 2003
- Resuscitation of the critically III in the ED: Responses of blood pressure, heart rate, shock index, central venous oxygen saturation, and lactateThe American Journal of Emergency Medicine, 1996
- A Comparison of the Shock Index and Conventional Vital Signs to Identify Acute, Critical Illness in the Emergency DepartmentAnnals of Emergency Medicine, 1994
- Shock index: a re-evaluation in acute circulatory failureResuscitation, 1992