Delta shock index in the emergency department as a predictor of clinical outcomes in traumatic injury

被引：0

作者：

Chen, Yu-Long ^{[1
,10
]}

Wu, Tsung-Hsien ^{[2
,10
]}

Liu, Chi-Yuan ^{[3
,10
]}

Wang, Chien-Hsing ^{[4
,10
]}

Tsai, Chia-Hung ^{[5
,6
,10
]}

Chung, Jui-Yuan ^{[7
,8
,9
,11
]}

Yiang, Giou-Teng ^{[1
,10
]}

Wu, Meng-Yu ^{[1
,10
,11
]}

机构：

[1] Taipei Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Dept Emergency Med, Taipei 231, Taiwan

[2] Dalin Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Dept Surg, Div Neurosurg, Chiayi, Taiwan

[3] Taipei Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Dept Orthoped Surg, New Taipei 231, Taiwan

[4] Hualien Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Dept Surg, Div Plast Surg, Hualien, Taiwan

[5] Hualien Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Trauma Ctr, Hualien, Taiwan

[6] Taichung Tzu Chi Hosp, Buddhist Tzu Chi Med Fdn, Dept Surg, Taichung, Taiwan

[7] Cathay Gen Hosp, Dept Emergency Med, Taipei, Taiwan

[8] Fu Fen Catholic Univ, Sch Med, Taipei, Taiwan

[9] Natl Tsing Hua Univ, Sch Med, Hsinchu, Taiwan

[10] Tzu Chi Univ, Sch Med, Hualien, Taiwan

[11] Taipei Med Univ, Grad Inst Injury Prevent & Control, Taipei, Taiwan

来源：

AMERICAN JOURNAL OF EMERGENCY MEDICINE | 2025年 / 92卷

关键词：

Trauma; Shock index; Delta shock index; Triage; SYSTOLIC BLOOD-PRESSURE; MASSIVE TRANSFUSION; MORTALITY; UTILITY; NEED; HYPOTENSION; PATIENT; TRIAGE; SCALE; CARE;

D O I：

10.1016/j.ajem.2025.02.041

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: The shock index (SI) is widely used to screen for patients in shock, and the dSI is created by utilizing prehospital SI and emergency department SI to enhance predictive accuracy. However, few have compared dSI with prehospital SI and SI at ED, and even fewer have explored the directional changes in dSI. This study aims to evaluate the prediction accuracy of prehospital SI, SI at ED, and delta SI in trauma patients, proposing that the delta scoring systems provide a more precise tool for field triage. Patients and methods: This study conducted a cohort analysis involving 48,524 patients from the trauma registry data at Tzu Chi Hospital. The three primary outcomes assessed were in-hospital mortality, intensive care unit (ICU) admission, and prolonged total length of hospital stay (>= 30 days). The area under the receiver operating characteristic curve (AUROC) for these scores was calculated and compared using the DeLong test. The delta SI was calculated as the difference between prehospital SI and SI at the emergency department (ED). The dSI was categorized into five groups: dSI < -0.5, -0.5 <= dSI < -0.1, -0.1 <= dSI < 0.1, 0.1 <= dSI < 0.5, and 0.5 <= dSI. Results: Prehospital SI, SI at ED, and dSI were significant predictors of in-hospital mortality, ICU admission, and prolonged length of stay (LOS) of >= 30 days. Compared to prehospital SI and SI at ED, dSI demonstrated significantly higher AUROC values in discriminating major injury, prolonged ICU stay, and in-hospital mortality. The groups with dSI < -0.5 and dSI >= 0.5 exhibited a significantly higher risk of in-hospital mortality compared to other dSI group with adjusted odds ratio (aOR) of 2.170 and 2.976. A J-shaped relationship in aOR values was observed across different dSI ranges for in-hospital mortality. The dSI >= 0.5 group had an increased risk of inhospital mortality among elderly patients, those with major or minor injuries, and both TBI and non-TBI groups. The dSI >= 0.1 demonstrated accuracies of 80.94 % for predicting ISS >= 16, 72.91 % for ICU admission, 87.14 % for prolonged LOS >= 30 days, and 89.33 % for predicting mortality. Conclusions: The dSI demonstrated significantly better discriminative ability for major injury, prolonged ICU stay, and in-hospital mortality. A potential J-shaped relationship has been identified between dSI and mortality, indicating that both the dSI < -0.5 and dSI >= 0.5 groups have a significantly higher risk of in-hospital mortality. It is anticipated that dSI will be integrated into clinical practice for the field triage of trauma patients in the futur e. (c) 2025 Published by Elsevier Inc.

引用

页码：10 / 17

页数：8

共 47 条

[11] Funabiki S., Et al., Delta shock index and higher incidence of emergency surgery in older adults with blunt trauma, Eur J Trauma Emerg Surg, 50, 2, pp. 561-566, (2024)
[12] Chien D.-S., Et al., Association of in-Hospital Mortality and Trauma Team Activation: a 10-year study, Diagnostics, 12, 10, (2022)
[13] Huang H.-K., Et al., The association between blood pressure and in-hospital mortality in traumatic brain injury: evidence from a 10-year analysis in a single-center, Am J Emerg Med, 58, pp. 265-274, (2022)
[14] Lee S.-J., Et al., A ten-year retrospective cohort study on neck collar immobilization in trauma patients with head and neck injuries, Medicina, 59, 11, (2023)
[15] Lin P.-C., Et al., The impact of holiday season and weekend effect on traumatic injury mortality: evidence from a 10-year analysis, Tzu-Chi Med J, 35, 1, (2023)
[16] Lin P.-C., Et al., Use of reverse shock index multiplied by simplified motor score in a five-level triage system: identifying trauma in adult patients at a high risk of mortality, Medicina, 60, 4, (2024)
[17] Lin P.-C., Et al., Prehospital shock index multiplied by the alert/verbal/painful/unresponsive score as a predictor of clinical outcomes in traumatic injury, Prehosp Emerg Care, pp. 1-21, (2024)
[18] Tsai C.-H., Et al., Association between time to emergent surgery and outcomes in trauma patients: a 10-year multicenter study, Medicina, 60, 6, (2024)
[19] Wu M.-Y., Et al., Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow coma scale predicting clinical outcomes in traumatic brain injury: evidence from a 10-year analysis in a single center, Front Med, (2022)
[20] Yang Y.-C., Et al., Prehospital shock index multiplied by AVPU scale as a predictor of clinical outcomes in traumatic injury, Shock, 58, 6, pp. 524-533, (2022)

← 1 2 3 4 5 →