Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients

• Published in: The American journal of emergency medicine Vol. 38; no. 2; pp. 187 - 190
• Main Authors: Wang, Il-Jae, Bae, Byung-Kwan, Park, Sung-Wook, Cho, Young-Mo, Lee, Dae-Sup, Min, Mun-Ki, Ryu, Ji-Ho, Kim, Gil-Hwan, Jang, Jae-Hoon
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2020; Elsevier Limited
• Subjects: Accuracy; Adult; Age; Aged; Area Under Curve; Blood pressure; Blood transfusion; Blood Transfusion - mortality; Blood Transfusion - statistics & numerical data; Emergency medical care; Emergency medical services; Emergency Medical Services - methods; Emergency Medical Services - trends; Female; Heart rate; Hemorrhagic shock; Humans; Injuries; Male; Middle Aged; Mortality; Patients; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; ROC Curve; Severity of Illness Index; Shock - classification; Shock - diagnosis; Shock - epidemiology; Statistical analysis; Transfusion; Trauma; Trauma centers; Wounds and Injuries - classification; Wounds and Injuries - complications; Wounds and Injuries - mortality; Republic of Korea; SBP; ABC; MSI; Hemorrhagic shock; KTDB; TASH; PRBC; MT; PACT; ROC; ISS; AUROC; HR; Trauma; Blood transfusion; DBP; SI; ICU; MAP; Emergency medical services; ED
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2019.01.056

Modified shock index (MSI) is a useful predictor in trauma patients. However, the value of prehospital MSI (preMSI) in trauma patients is unknown. The aim of this study was to investigate the accuracy of preMSI in predicting massive transfusion (MT) and hospital mortality among trauma patients.
This was a retrospective, observational, single-center study. Patients presenting consecutively to the trauma center between January 2016 and December 2017, were included. The predictive ability of both prehospital shock index (preSI) and preMSI for MT and hospital mortality was assessed by calculating the areas under the receiver operating characteristic curves (AUROCs).
A total of 1007 patients were included. Seventy-eight (7.7%) patients received MT, and 30 (3.0%) patients died within 24 h of admission to the trauma center. The AUROCs for predicting MT with preSI and preMSI were 0.773 (95% confidence interval [CI], 0.746–0.798) and 0.765 (95% CI, 0.738–0.791), respectively. The AUROCs for predicting 24-hour mortality with preSI and preMSI were 0.584 (95% CI, 0.553–0.615) and 0.581 (95% CI, 0.550–0.612), respectively.
PreSI and preMSI showed moderate accuracy in predicting MT. PreMSI did not have higher predictive power than preSI. Additionally, in predicting hospital mortality, preMSI was not superior to preSI.