Extremes of shock index predicts death in trauma patients

Stephen R Odom; Michael D Howell; Alok Gupta; George Silva; Charles H Cook; Daniel Talmor

doi:10.4103/0974-2700.185272

Extremes of shock index predicts death in trauma patients

J Emerg Trauma Shock. 2016 Jul-Sep;9(3):103-6. doi: 10.4103/0974-2700.185272.

Authors

Stephen R Odom¹, Michael D Howell², Alok Gupta¹, George Silva³, Charles H Cook¹, Daniel Talmor⁴

Affiliations

¹ Department of Surgery, Division of Acute Care Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
² Division of Pulmonary, Critical Care, and Sleep Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
³ Beth Israel Deaconess Medical Center, Boston, MA, USA.
⁴ Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Abstract

Context: We noted a bimodal relationship between mortality and shock index (SI), the ratio of heart rate to systolic blood pressure.

Aims: To determine if extremes of SI can predict mortality in trauma patients.

Settings and designs: Retrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States.

Materials and methods: We examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries.

Statistical analysis used: Descriptive statistics and multivariable logistic regression.

Results: SI values demonstrated a U-shaped relationship with mortality. Compared with patients with a SI between 0.5 and 0.7, patients with a SI of <0.3 had an odds ratio for death of 2.2 (95% confidence interval [CI] 21.2-4.1) after adjustment for age, Glasgow Coma score, and injury severity score while patients with SI >1.3 had an odds ratio of death of 3.1. (95% CI 1.6-5.9). Elevated SI is associated with increased mortality in patients with isolated torso injuries, and is associated with death at both low and high values in patients with head injury.

Conclusion: Our data indicate a bimodal relationship between SI and mortality in head injured patients that persists after correction for various co-factors. The distribution of mortality is different between head injured patients and patients without head injuries. Elevated SI predicts death in all trauma patients, but low SI values only predict death in head injured patients.

Keywords: Mortality in trauma; shock; shock index.