Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank

Authors: Akio Kimura, Noriko Tanaka

Published in: Critical Care | Issue 1/2018

Login to get access

Abstract

Background

The shock index (SI), defined as heart rate (HR) divided by systolic blood pressure (SBP), is reported to be a more sensitive marker of shock than traditional vital signs alone. In previous literature, use of the reverse shock index (rSI), taken as SBP divided by HR, is recommended instead of SI for hospital triage. Among traumatized patients aged > 55 years, SI multiplied by age (SIA) might provide better prediction of early post-injury mortality. Separately, the Glasgow Coma Scale (GCS) score has been shown to be a very strong predictor. When considering these points together, rSI multiplied by GCS score (rSIG) or rSIG divided by age (rSIG/A) could provide even better prediction of in-hospital mortality.

Methods

This retrospective, multicenter study used data from 168,517 patients registered in the Japan Trauma Data Bank for the period 2006–2015. We calculated areas under receiver operating characteristic curves (AUROCs) to measure the discriminant ability by comparing those of SI (or rSI), SIA, rSIG, and rSIG/A for in-hospital mortality and for 24-h blood transfusion.

Results

The highest ROC AUC (AUROC), 0.901(0.894–0.908) for in-hospital mortality in younger patients (aged < 55 years), was seen for rSIG. In older patients (aged ≥ 55 years), the AUROC of rSIG/A, 0.845(0.840–0.850), was highest for in-hospital mortality. However, the difference between rSIG and rSIG/A was slight and did not seem to be clinically important. rSIG also had the highest AUROC of 0.745 (0.741–749) for 24-h blood transfusion.

Conclusions

rSIG ((SBP/HR) × GCS score) is easy to calculate without the need for additional information, charts or equipment, and can be a more reliable triage tool for identifying risk levels in trauma patients.
Literature
1.
Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24:685–90.CrossRefPubMed
2.
King RW, Plewa MC, Buderer NM, Knotts FB. Shock index as a marker for significant injury in trauma patients. Acad Emerg Med. 1996;3:1041–5.CrossRefPubMed
3.
Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67:1426–30.CrossRefPubMed
4.
Vandromme MJ, Griffin RL, Kerby JD, McGwin G Jr, Rue LW 3rd, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011;70:384–8.CrossRefPubMed
5.
Mutschler M, Nienaber U, Münzberg M, Wölfl C, Schoechl H, PaffrathT BB, Maegele M, the TraumaRegister DGU ®. The Shock Index revisited – a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU ®. Crit Care. 2013;17:R172.
6.
Fröhlich M, Driessen A, Böhmer A, Nienaber U, Igressa A, Probst C, Bouillon B, Maegele M, Mutschler M. 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 ®. Scandn J Trauma Resusc Emergy Med. 2016;24:148.CrossRef
7.
Zarzaur BL, Croce MA, Fischer PE, Magnotti LJ, Fabian TC. New vitals after injury: shock index for the young and age x shock index for the old. J Surg Res. 2008;147:229–36.CrossRefPubMed
8.
Zarzaur BL, Croce MA, Magnotti LJ, Fabian TC. Identifying life-threatening shock in the older injured patients an analysis of the national trauma data bank. J Trauma. 2010;68:1134–8.CrossRefPubMed
9.
Teasdale G, Jennett B. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81–4.CrossRefPubMed
10.
Geasdale G, Murray G, Parker L, Jennett B. Adding up the Glasgow Coma Score. Acta Neurochir Suppl (Wien). 1979;28:13.
11.
Kimura A, Chadbunchachai W, Nakahara S. Modification of the trauma and injury Severity Score (TRISS) method provides better survival prediction in Asian blunt trauma Victims. World J Surg. 2012;36:81–8.CrossRef
12.
Kimura A, Nakahara S, Chadbunchachai W. The development of simple survival prediction models for blunt trauma victims treated at Asian emergency centers. Scandn J Trauma Resusc Emergy Med. 2012;20:9.CrossRef
13.
Chuang JF, Rau CS, Wu SC, Liu HT, Hsu SY, Hsieh HY, Chen YC, Hsieh CH. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Scandn J Trauma Resusc Emergy Med. 2016;24:12.CrossRef
14.
Kuo SC, Kuo PJ, Hsu SY, Rau CS, Chen YC, Hsieh HY, Hsieh CH. The use of the reverse shock index to identify high-risk trauma patients in addition to the criteria for trauma team activation: a cross-sectional study based on a trauma registry system. BMJ Open. 2016;6:e011072.CrossRefPubMedPubMedCentral
15.
16.
Kondo Y, Abe T, Kohshi K, Tokuda Y, Cook EF, Kukita I. Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score. Crit Care. 2011;15:R191.CrossRefPubMedPubMedCentral
17.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristics curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRefPubMed
18.
19.
Mock C, Juillard C, Brundage S, editors. Guidelines for trauma quality improvement programs. Geneva: World Health Organization; 2009.
20.
Baker SP, O’Neill B, Haddon W. The Injury Severity Score. A method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.CrossRefPubMed
21.
Association for the Advancement of Automotive Medicine, Committee on Injury Scaling. The Abbreviated Injury Scale 2005 Update 2008. Des Plains: Association for the Advancement of Automotive Medicine; 2008.
22.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the Trauma Score. J Trauma. 1989;29:623–9.CrossRefPubMed
23.
Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: the TRISS method. Trauma Score and the Injury Severity Score. J Trauma. 1987;27:370–8.CrossRefPubMed
24.
Osler TM, Rogers FB, Badger GJ, Healey M, Vane DW, Shackford SR. A simple mathematical modification of TRISS markedly improves calibration. J Trauma. 2002;53:630–4.CrossRefPubMed
25.
Kilgo PD, Meredith JW, Osler TM. Incorporating recent advances to make the TRISS approach universally available. J Trauma. 2006;60:1002–8.CrossRefPubMed
26.
Nakahara S, Ichikawa M, Kimura A. Simplified alternative to the TRISS method for resource-constrained settings. World J Surg. 2011;35:512–9.CrossRefPubMed
27.
Allgower M, Burri C. Schockindex. Dtsch Med Wochenschr. 1967;43:1–10.
Metadata
Title
Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank
Authors
Akio Kimura
Noriko Tanaka
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2014-0

Other articles of this Issue 1/2018

Critical Care 1/2018 Go to the issue

Research

Delay in antibiotic therapy results in fatal disease outcome in murine pneumococcal pneumonia

Letter

Response to “Categorization of post-cardiac arrest patients according to the pattern of amplitude-integrated electroencephalography after return of spontaneous circulation”

Research

Impact of a remifentanil supply shortage on mechanical ventilation in a tertiary care hospital: a retrospective comparison

Research

Worldwide audit of blood transfusion practice in critically ill patients

Review

Aerosolized antibiotics for ventilator-associated pneumonia: a pairwise and Bayesian network meta-analysis

Research

Intraoperative milrinone versus dobutamine in cardiac surgery patients: a retrospective cohort study on mortality