+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank



Shock index predicts mortality in geriatric trauma patients: an analysis of the National Trauma Data Bank



Journal of Trauma and Acute Care Surgery 76(4): 1111-1115



Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients. We performed a 4-year (2007-2010) retrospective analysis using the National Trauma Data Bank. Patients 65 years or older were included. Transferred patients, patients dead on arrival, missing vitals on presentation, and patients with burns and traumatic brain injury were excluded. A cutoff value of SI greater than or equal to 1 (sensitivity, 81%; specificity, 79%) was used to define hemodynamic instability. The primary outcome measure was mortality. Secondary outcome measures were need for blood transfusion, need for exploratory laparotomy, and development of in-hospital complications. Multiple logistic regressions were performed. A total of 485,595 geriatric patients were reviewed, of whom 217,190 were included. The mean (SD) age was 77.7 (7.1) years, 60% were males, median Glasgow Coma Scale (GCS) score was 14 (range, 3-15), median Injury Severity Score (ISS) was 9 (range, 4-18), and mean (SD) SI was 0.58 (0.18). Three percent (n = 6,585) had an SI greater than or equal to 1. Patients with SI greater than or equal to 1 were more likely to require blood product requirement (p = 0.001), require an exploratory laparotomy (p = 0.01), and have in-hospital complications (p = 0.02). The overall mortality rate was 4.1% (n = 8,952). SI greater than or equal to 1 was the strongest predictor for mortality (odds ratio, 3.1; 95% confidence interval, 2.6-3.3; p = 0.001) in geriatric trauma patients. Systolic blood pressure (p = 0.09) and heart rate (p = 0.2) were not predictive of mortality. SI is an accurate and specific predictor of morbidity and mortality in geriatric trauma patients. SI is superior to heart rate and systolic blood pressure for predicting mortality in geriatric trauma patients. Geriatric trauma patients with SI greater than or equal to 1 should be transferred to a Level 1 trauma center. Prognostic/epidemiologic study, level III.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 055756326

Download citation: RISBibTeXText

PMID: 24662879

DOI: 10.1097/ta.0000000000000160


Related references

Reverse shock index multiplied by Glasgow Coma Scale score (rSIG) is a simple measure with high discriminant ability for mortality risk in trauma patients: an analysis of the Japan Trauma Data Bank. Critical Care 22(1): 87, 2018

Timing of mortality in pediatric trauma patients: A National Trauma Data Bank analysis. Journal of Pediatric Surgery 53(2): 344-351, 2017

Predictors of mortality among initially stable adult pelvic trauma patients in the US: Data analysis from the National Trauma Data Bank. Injury 46(11): 2113-2117, 2016

Impact of the 80-Hour Work Week on Mortality and Morbidity in Trauma Patients: An Analysis of the National Trauma Data Bank. Yearbook of Critical Care Medicine 2010: 297-299, 2010

Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Annals of Surgery 259(2): E16, 2014

Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Annals of Surgery 253(2): 371-377, 2011

Impact of the 80-hour work week on mortality and morbidity in trauma patients: an analysis of the National Trauma Data Bank. Journal of Surgical Research 154(1): 157-162, 2008

Geriatric assault victims treated at U.S. trauma centers: Five-year analysis of the national trauma data bank. Injury 47(12): 2671-2678, 2016

Ocular injuries in trauma patients: an analysis of 28,340 trauma admissions in the 2003-2007 National Trauma Data Bank National Sample Program. Journal of Trauma and Acute Care Surgery 73(5): 1308-1312, 2013

Impact of ACA-related Insurance Expansion Policies on Mortality and Access to Post-Discharge Care for Trauma Patients: An Analysis of the National Trauma Data Bank. Journal of Trauma and Acute Care Surgery 2018, 2018

Evidence of Hormonal Basis for Improved Survival Among Females With Trauma-Associated Shock: An Analysis of the National Trauma Data Bank. Yearbook of Critical Care Medicine 2011: 252-253, 2011

Evidence of hormonal basis for improved survival among females with trauma-associated shock: an analysis of the National Trauma Data Bank. Journal of Trauma 69(3): 537-540, 2010

Validation of the Shock Index, Modified Shock Index, and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments. Journal of Korean Medical Science 31(12): 2026-2032, 2017

Comparison of modified Kampala trauma score with trauma mortality prediction model and trauma-injury severity score: A National Trauma Data Bank Study. American Journal of Emergency Medicine 35(8): 1056-1059, 2017

Excess mortality, length of stay, and costs associated with serious hemorrhage among trauma patients: findings from the National Trauma Data Bank. American Surgeon 73(12): 1269-1274, 2008