Shock index in patients with traumatic solid organ injury as a predictor of massive blood transfusion protocol activation

PurposeWe aimed to assess the utility of shock index (SI) to predict the need for massive transfusion protocol (MTP) in patients with solid organ injury (SOI) in a Level 1 Trauma center.MethodsWe conducted a retrospective analysis for patients with SOI between 2011 and 2014. Patients were categorized according to on-admission SI into low (<0.8) and high SI (<greater than or equal to>0.8) group.ResultsA total of 4500 patients were admitted with trauma, of them 572 sustained SOIs (289 patients had SI >= 0.8). In comparison to low SI, patients with high SI were younger, had higher injury severity scores (ISS) and lower Trauma and Injury Severity Score (TRISS); (p<0.001). The proportion of exploratory laparotomy (EXLap), blood transfusion (BT), MTP activation, sepsis and hospital mortality were significantly higher in patients with high SI. Serum lactate (r=0.34), hematocrit (r=-0.34), ABC score (r=0.62), ISS (r=0.35), and amount of transfused blood (r=0.22) were significantly correlated with SI. On multivariable regression analysis using 9 relevant variables (age, sex, ISS, ED GCS, serum lactate, hematocrit, Abdomen AIS and Focused assessment with sonography in trauma (FAST) and SI), SI<greater than or equal to>0.8 was an independent predictor of BT (OR 2.80; 95%CI 1.56-4.95) and MTP (OR 2.81;95% CI 1.09-7.21) .ConclusionsIn patients with SOI, SI is a simple bedside predictor for BT and MTP activation. Further prospective studies are needed to support our findings.