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Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury.

ABSTRACT: The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS]???16) with head injury (head Abbreviated Injury Scale [AIS]???2) in the emergency department (ED). This retrospective case control study recruited adult severe trauma patients (ISS???16) with head injury (head AIS???2) who presented to the ED of two major trauma centers between January 01, 2014 and May 31, 2017. Demographic data, vital signs, ISS scores, injury mechanisms, laboratory data, managements, and outcomes were included for the analysis. Logistic regression and receiver operating characteristic analysis were used to evaluate the accuracy of rSIG score in predicting in-hospital mortality. In total, 438 patients (mean age: 56.48 years; 68.5% were males) were included in this study. In-hospital mortality occurred in 24.7% patients. The median (interquartile range) ISS score was 20 (17-26). Patients with rSIG???14 had seven-fold increased risks of mortality than those without rSIG???14 (odds ratio: 7.64; 95% confidence interval: 4.69-12.42). Hosmer-Lemeshow goodness-of-fit test and area under the curve values for rSIG score were 0.29 and 0.76, respectively. The sensitivity, specificity, positive predictive value, and negative predictive values of rSIG???14 were 0.71, 0.75, 0.49, and 0.89, respectively. The rSIG score is a prompt and simple tool to predict in-hospital mortality among adult severe trauma patients with head injury.

SUBMITTER: Wan-Ting C

PROVIDER: S-EPMC7005840 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury.

Wan-Ting Chu C Chin-Hsien Liao L Cheng-Yu Lin L Cheng-Yu Chien C Chi-Chun Lin L Keng-Wei Chang C Jiann-Hwa Chen C Wei-Lung Chen C Chien-Cheng Huang H Cherng-Jyr Lim L Jui-Yuan Chung C

Scientific reports 20200207 1

The reverse shock index (rSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), is used to identify prognosis in trauma patients. Multiplying rSI by Glasgow Coma Scale (rSIG) can possibly predict better in-hospital mortality in patients with trauma. However, rSIG has never been used to evaluate the mortality risk in adult severe trauma patients (Injury Severity Score [ISS] ≥ 16) with head injury (head Abbreviated Injury Scale [AIS] ≥ 2) in the emergency department (ED). This retrospe ...[more]

PMID: 32034233

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Project description:The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

Project description:The shock index (SI) and its derivations, the modified shock index (MSI) and the age shock index (Age SI), have been used to identify trauma patients with unstable hemodynamic status. The aim of this study was to evaluate their use in predicting the requirement for massive transfusion (MT) in trauma patients upon arrival at the hospital. A patient receiving transfusion of 10 or more units of packed red blood cells or whole blood within 24 h of arrival at the emergency department was defined as having received MT. Detailed data of 2490 patients hospitalized for trauma between 1 January 2009, and 31 December 2014, who had received blood transfusion within 24 h of arrival at the emergency department, were retrieved from the Trauma Registry System of a level I regional trauma center. These included 99 patients who received MT and 2391 patients who did not. Patients with incomplete registration data were excluded from the study. The two-sided Fisher exact test or Pearson chi-square test were used to compare categorical data. The unpaired Student t-test was used to analyze normally distributed continuous data, and the Mann-Whitney U-test was used to compare non-normally distributed data. Parameters including systolic blood pressure (SBP), heart rate (HR), hemoglobin level (Hb), base deficit (BD), SI, MSI, and Age SI that could provide cut-off points for predicting the patients' probability of receiving MT were identified by the development of specific receiver operating characteristic (ROC) curves. High accuracy was defined as an area under the curve (AUC) of more than 0.9, moderate accuracy was defined as an AUC between 0.9 and 0.7, and low accuracy was defined as an AUC less than 0.7. In addition to a significantly higher Injury Severity Score (ISS) and worse outcome, the patients requiring MT presented with a significantly higher HR and lower SBP, Hb, and BD, as well as significantly increased SI, MSI, and Age SI. Among these, only four parameters (SBP, BD, SI, and MSI) had a discriminating power of moderate accuracy (AUC > 0.7) as would be expected. A SI of 0.95 and a MSI of 1.15 were identified as the cut-off points for predicting the requirement of MT, with an AUC of 0.760 (sensitivity: 0.563 and specificity: 0.876) and 0.756 (sensitivity: 0.615 and specificity: 0.823), respectively. However, in the groups of patients with comorbidities such as hypertension, diabetes mellitus, or coronary artery disease, the discriminating power of these three indices in predicting the requirement of MT was compromised. This study reveals that the SI is moderately accurate in predicting the need for MT. However, this predictive power may be compromised in patients with HTN, DM or CAD. Moreover, the more complex calculations of MSI and Age SI failed to provide better discriminating power than the SI.

Dataset Information

Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury.

Publications

Reverse shock index multiplied by Glasgow Coma Scale (rSIG) predicts mortality in severe trauma patients with head injury.

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