Citation

Kimura A, Tanaka N. Crit. Care 2018; 22(1): e87.

Affiliation

Biostatistics Section, Department of Data Science, Clinical Science Center, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, 162-8655, Japan.

Copyright

(Copyright © 2018, Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s13054-018-2014-0

PMID

29642920

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.

Language: en

Keywords

Glasgow Coma Scale score; Heart rate; In-hospital mortality; Japan Trauma Data Bank; Systolic blood pressure