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Med Intensiva. 2017 Dec;41(9):532-538. doi: 10.1016/j.medin.2016.10.016. Epub 2017 Apr 8.

Prediction of massive bleeding. Shock index and modified shock index.

[Article in English, Spanish]

Author information

1
Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: luchoter000@hotmail.com.
2
Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.

Abstract

OBJECTIVE:

To determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma.

DESIGN:

Retrospective cohort.

SETTING:

Severe trauma patient's initial attention at the intensive care unit of a tertiary hospital.

SUBJECTS:

Patients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015.

VARIABLES:

We studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV-), positive and negative likelihood ratio (LR+ and LR-), ROC curves (Receiver Operating Characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage.

RESULTS:

287 patients were included, 76.31% (219) were male, mean age was 43,36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21-34). The overall frequency of massive bleeding was 8.71% (25). For Shock Index: AUROC was 0.89 (95% confidence intervals [CI] 0.84 to 0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2 to 97.58) and Sp was 79.69% (95% CI: 74.34 to 84.16). For the Modified Shock Index: AUROC was 0.90 (95% CI: 0.86 to 0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01 to 99.23) and Sp was 75.78% (95% CI: 70.18 to 80.62).

CONCLUSION:

Shock Index and Modified Shock Index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma.

KEYWORDS:

Escala de severidad del trauma; Escala de trauma revisado; Hemorragia masiva; Injury severity score; Massive bleeding; Massive transfussion; Modified shock index; Revised trauma score; Shock index; Transfusión masiva; Índice de shock; Índice de shock modificado

PMID:
28396047
DOI:
10.1016/j.medin.2016.10.016
[Indexed for MEDLINE]
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