Prehospital shock index predicts 24-h mortality in trauma patients with a normal shock index upon emergency department arrival.
The American journal of emergency medicine · 2023-05-10 · Observational study
Abstract
BACKGROUND: The shock index (heart rate divided by systolic blood pressure) of trauma patients upon emergency department arrival predicts blood loss and death. However, some patients with normal shock indices (0.4 < shock index <0.9) upon emergency department arrival also have poor prognoses. This study aimed to determine whether abnormal prehospital shock indices in trauma patients with normal shock indices upon emergency department arrival were predictors of a high risk of mortality. METHODS: We conducted a retrospective cohort study of emergency department-admitted trauma patients from 2004 to 2017. The study included 89,495 consecutive trauma patients aged ≥16 years, with Abbreviated Injury Scale score of ≥3, who were transported to the emergency department directly from the field and had a normal shock index upon emergency department arrival. According to the prehospital shock index scores, the patients were categorized into low shock index (≤ 0.4), normal shock index, and high shock index (≥0.9) groups. Odds ratios and 95% confidence intervals were calculated using logistic regression analysis. RESULTS: The 89,495 patients had a median age of 64 (interquartile range: 43-79) years, and 55,484 (62.0%) of the patients were male. There were 1350 (1.5%) 24-h deaths in total; 176/4263 (4.1%), 1017/78,901 (1.3%), and 157/6331 (2.5%) patients were in the low, normal, and high prehospital shock index groups, respectively. The adjusted odds ratios for 24-h mortality compared with the normal shock index group were 1.63 (95% confidence interval: 1.34-1.99) in the low shock index group and 1.62 (95% confidence interval: 1.31-1.99) in the high shock index group. CONCLUSION: Trauma patients with abnormal prehospital shock indices but normal shock indices upon emergency department arrival are at a higher risk of 24-h mortality. Identifying these indices could improve triage and targeted care for patients.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Early warning scores · Mortality & survival · Older adults
Related articles
- An analysis of shock index as a correlate for outcomes in trauma by age group. (Surgery, 2013)
- "Are prehospital shock, modified shock, age-adjusted shock indices and some scoring systems effective in predicting the prognosis of high-energy trauma Patients?". (Int Emerg Nurs, 2025)
- Prehospital Shock Index Multiplied by the Alert/Verbal/Painful/Unresponsive Score as a Predictor of Clinical Outcomes in Traumatic Injury. (Prehosp Emerg Care, 2024)
- Association between prehospital field to emergency department delta shock index and in-hospital mortality in patients with torso and extremity trauma: A multinational, observational study. (PLoS One, 2021)
- Prehospital serum lactate as a predictor of outcomes in trauma patients: a retrospective observational study. (J Trauma, 2011)
- Diagnostic accuracy of shock index, revised trauma score, and injury severity score for mortality prediction in trauma: A hierarchical meta-analysis. (Injury, 2026)