New vitals after injury: Shock index for the young and age x shock index for the old
New vitals after injury: Shock index for the young and age x shock index for the old
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DOI：
10.1016/j.jss.2008.03.025
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发表时间：
2008-06-15
影响因子：
2.2
通讯作者：
Fabian, Timothy C.
中科院分区：
文献类型：
--
作者：
Zarzaur, Ben L.;Croce, Martin A.;Fabian, Timothy C.
背景资料。传统观点认为，心动过速和低血压伴随着创伤后失血性休克，这一观点受到了挑战。在年龄极端的时候，这一点尤其正确。休克指数(SI)可能是损伤后危及生命的出血的一个替代指标。因为年龄对生理储备有负面影响，我们假设年龄乘以SI(年龄x SI)比心率(HR)、收缩压(SBP)或SI更能预测48小时死亡率(48mort)。I级创伤中心登记用于识别1996-2005年间收治的18-84岁(55岁以下)的钝性损伤患者。排除有头部和脊髓损伤的患者。主要结果是48mort。确定每个预测者的受试者工作特征曲线(AUC)下的面积。确定了16,077名患者。其中青年组为0.93%，老年组为3.17%；P<；0.0001。总体而言，SI(Auc 0.812)和年龄x SI(Auc 0.831)比单独的HR(Auc 0.716，P<；0.0001)或SBP(Auc 0.753，P=0.0004)更能预测48Mort。在老年患者中，年龄x SI(AUC 0.828)比HR(AUC 0.659 P<；0.0001)、SBP(AUC 0.762 P=0.003)或SI(AUC 0.787 P=0.0005)更能预测48Mort。与单纯HR或SBP相比，SI和年龄×SI更能预测受伤患者的48MORT。应使用SI和年龄x SI来确定损伤后早期死亡的风险。(C)2008 Elsevier Inc.保留所有权利。
Background. The traditional view that tachycardia and hypotension accompany hemorrhagic shock following injury has been challenged. This is particularly true at extremes of age. Shock index (SI) may be an alternative indicator of life-threatening bleeding after injury. Because age negatively impacts physiological reserve, we hypothesized that age multiplied by SI (Age x SI) would be a better predictor of 48 h mortality (48 MORT) compared to heart rate (HR), systolic blood pressure (SBP), or SI.Methods. A Level I trauma center registry was used to identify victims of blunt injury, aged 18-84 (YOUNG 55) admitted from 1996-2005. Patients with head and spinal cord injury injuries were excluded. The main outcome was 48 MORT. Areas under the receiver operating characteristic curves (AUC) for each predictor were determined.Results. Sixteen thousand seventy-seven patients were identified. Forty-eight MORT was 1.27% (0.93% in YOUNG and 3.17% in OLD; P < 0.0001). Overall, SI (AUC 0.812) and Age x SI (AUC 0.831) were better predictors of 48 MORT compared to HR (AUC 0.716, P < 0.0001) or SBP (AUC 0.753, P = 0.0004) alone. In OLD patients, AGE x SI (AUC 0.828) was a better predictor of 48 MORT compared to HR (AUC 0.659 P < 0.0001), SBP (AUC 0.762 P = 0.003), or SI (AUC 0.787 P = 0.0005).Conclusion. SI and Age x SI are better predictors of 48 MORT in injured patients than HR or SBP alone. SI and Age x SI should be used to identify patients at risk for early mortality following injury. (C) 2008 Elsevier Inc. All rights reserved.