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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2016

Open Access 01-12-2016 | Original research

Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?—an analysis of the TraumaRegister DGU®

Authors: Matthias Fröhlich, Arne Driessen, Andreas Böhmer, Ulrike Nienaber, Alhadi Igressa, Christian Probst, Bertil Bouillon, Marc Maegele, Manuel Mutschler, and the TraumaRegister DGU

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2016

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Abstract

Background

A new classification of hypovolemic shock based on the shock index (SI) was proposed in 2013. This classification contains four classes of shock and shows good correlation with acidosis, blood product need and mortality. Since their applicability was questioned, the aim of this study was to verify the validity of the new classification in multiple injured patients with traumatic brain injury.

Methods

Between 2002 and 2013, data from 40 888 patients from the TraumaRegister DGU® were analysed. Patients were classified according to their initial SI at hospital admission (Class I: SI < 0.6, class II: SI ≥0.6 to <1.0, class III SI ≥1.0 to <1.4, class IV: SI ≥1.4). Patients with an additional severe TBI (AIS ≥ 3) were compared to patients without severe TBI.

Results

16,760 multiple injured patients with TBI (AIShead ≥3) were compared to 24,128 patients without severe TBI. With worsening of SI class, mortality rate increased from 20 to 53% in TBI patients. Worsening SI classes were associated with decreased haemoglobin, platelet counts and Quick’s values. The number of blood units transfused correlated with worsening of SI. Massive transfusion rates increased from 3% in class I to 46% in class IV. The accuracy for predicting transfusion requirements did not differ between TBI and Non TBI patients.

Discussion

The use of the SI based classification enables a quick assessment of patients in hypovolemic shock based on universally available parameters. Although the pathophysiology in TBI and Non TBI patients and early treatment methods such as the use of vasopressors differ, both groups showed an identical probability of recieving blood products within the respective SI class.

Conclusion

Regardless of the presence of TBI, the classification of hypovolemic shock based on the SI enables a fast and reliable assessment of hypovolemic shock in the emergency department. Therefore, the presented study supports the SI as a feasible tool to assess patients at risk for blood product transfusions, even in the presence of severe TBI.
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Metadata
Title
Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?—an analysis of the TraumaRegister DGU®
Authors
Matthias Fröhlich
Arne Driessen
Andreas Böhmer
Ulrike Nienaber
Alhadi Igressa
Christian Probst
Bertil Bouillon
Marc Maegele
Manuel Mutschler
and the TraumaRegister DGU
Publication date
01-12-2016
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-016-0340-2

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