Utility of the Shock Index in Predicting Mortality in Traumatically Injured Patients
Utility of the Shock Index in Predicting Mortality in Traumatically Injured Patients
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DOI：
10.1097/ta.0b013e3181bbf728
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Moncure, Michael
中科院分区：
文献类型：
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作者：
Cannon, Chad M.;Braxton, Carla C.;Moncure, Michael
背景：目前，特定的分诊标准，如血压、呼吸状态、格拉斯哥昏迷评分和损伤机制，被用于对创伤患者进行分类，并对急诊科(Ed)和创伤团队的反应进行优先排序。以前的文献已经证明，休克指数异常(SI=心率[HR]/收缩压，>；0.9)预示着危重患者预后更差。我们的研究旨在评估现场计算的SI，到达急诊室时，以及现场和ED值之间的变化作为预测创伤患者死亡率的简单和早期的标志。方法：对城市I级创伤中心的创伤登记进行回顾性图表回顾。分析了2,445名在创伤登记处有记录的5年来入院的患者，其中1,166人也有现场SI的数据。从野外到ED的SI增加被定义为SI的任何增加，无论变化的程度如何。结果：22%的受检者的ED SI>；0.9，死亡率为15.9%，而ED SI正常的患者为6.3%。野性和ED之间SI的增加表明，SI降低或不变的患者的死亡率为9.3%和5.7%。SI为0.3的患者的死亡率为27.6%，而SI为0.9的患者的死亡率为5.8%。从现场到ED的SI增加可能预示着更高的死亡率。SI可能是目前用于激活创伤团队反应的其他急诊分诊标准的有价值的补充。
Background: Currently, specific triage criteria, such as blood pressure, respiratory status, Glasgow Coma Scale, and mechanism of injury are used to categorize trauma patients and prioritize emergency department (ED) and trauma team responses. It has been demonstrated in previous literature that an abnormal shock index (SI = heart rate [HR]/systolic blood pressure, >0.9) portends a worse outcome in critically ill patients. Our study looked to evaluate the SI calculated in the field, on arrival to the ED, and the change between field and ED values as a simple and early marker to predict mortality in traumatically injured patients.Methods: A retrospective chart review of the trauma registry of an urban level I trauma center. Analysis of 2,445 patients admitted over 5 years with records in the trauma registry of which 1, 166 also had data for the field SI. An increase in SI from the field to the ED was defined as any increase in SI regardless of the level of the magnitude of change.Results: Twenty-two percent of patients reviewed had an ED SI >0.9, with a mortality rate of 15.9% compared with 6.3% in patients with a normal ED SI. An increase in SI between the field and ED signaled a mortality rate of 9.3% versus 5.7% for patients with decreasing or unchanged SI. Patients with an increase in SI of >= 0.3 had a mortality rate of 27.6% versus 5.8% for patients with change in SI of 0.9 have higher mortality rates. An increase in SI from the field to the ED may predict higher mortality. The SI may be a valuable addition to other ED triage criteria currently used to activate trauma team responses.