Sage Journals: Discover world-class research

Abstract

Introduction

The role of elevated shock index is increasingly recognized as a vital indicator in the assessment of mortality rates in trauma patients. Its role in combination with other parameters is crucial yet underexplored in predicting outcomes. We hypothesized that qualitative assessment of elevated admission shock index, elevated base deficit/excess, and elevated lactate in combination would best predict mortality after blunt trauma.

Methods

This study was a retrospective review of trauma registry data on blunt trauma patients from 2012 to 2021 at a level 1 trauma center to evaluate the impact of elevated SI (>0.7), elevated lactate 2 mmol/L to 5 mmol/L, and elevated base deficit ≤-2 mmol/L at admission on predicting mortality. We used these parameters as qualitative and categorical predictors rather than continuous measures. A multivariate logistic regression model was developed, with shock index severity stratification and mortality as primary outcomes.

Results

A total of 4794 patients (151 non-survivors) were included in the analysis. Non-survivors had higher rates of elevated SI + elevated lactate + elevated BD (13.9% vs 5.8%, P < 0.001) with highest overall OR (11.7, P < 0.001) compared to other parameters (age 5.5, severe ISS 9.5, and GCS <8 10.3). When stratified by severity, patients with moderate SI (1.0 < SI <1.4) had a significantly increased risk of mortality in combination with elevated lactate and elevated base deficit (OR 21.1, P < 0.001).

Conclusion

We previously reported a qualitative model predicting blunt trauma mortality rates using elevated lactate and elevated base deficit. Combining admission SI, whether mild and moderate, with elevated lactate and elevated base deficit as qualitative “elevated” biomarkers yielded a more robust predictive model and highest OR for predicting mortality in blunt trauma non-survivors, with an 11.7-fold increase compared to survivors. This was higher than the individual parameters or other combinations.

Keywords

trauma trauma acute care acute care surgery

Get full access to this article

View all access options for this article.

References

Rossiter

. Trauma-the forgotten pandemic? Int Orthop. 2022;46(1):3-11.

Chen

Liu

Feng

Wei

. A novel strategy for predicting 72-h mortality after admission in patients with polytrauma: a study on the development and validation of a web-based calculator. Front Med. 2022;9:799811.

Gerdin

Roy

Khajanchi

, et al. Predicting early mortality in adult trauma patients admitted to three public university hospitals in urban India: a prospective multicentre cohort study. PLoS One. 2014;9(9):e105606.

Abdelhamid

Scioscia

Vodovotz

, et al. Multi-omic admission-based prognostic biomarkers identified by machine learning algorithms predict patient recovery and 30-Day survival in trauma patients. Metabolites. 2022;12(9):774.

Koch

Lovett

Nghiem

Riggs

Rech

. Shock index in the emergency department: utility and limitations. Open Access Emerg Med. 2019;11:179-199.

Bardes

Price

Adjeroh

Doretto

Wilson

. Emergency medical services shock index is the Most accurate predictor of patient outcomes after blunt torso trauma. J Trauma Acute Care Surg. 2022;92(3):499-503.

Asim

El-Menyar

Abdelrahman

, et al. Time and risk factors of trauma-related mortality: a 5-Year retrospective analysis from a national level I trauma center. J Intensive Care Med. 2024;39:8850666231225607.

Cannon

Braxton

Kling-Smith

Mahnken

Carlton

Moncure

. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67(6):1426-1430.

Saeed

Wilson

Bloos

, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care. 2019;23(1):40.

10.

Stoessel

Artemova

, et al. Early prediction of in-hospital mortality utilizing multivariate predictive modelling of electronic medical records and socio-determinants of health of the first day of hospitalization. BMC Med Inform Decis Mak. 2023;23(1):259.

11.

Vodovotz

Abdelhamid

, et al. Multi-omic analysis in injured humans: patterns align with outcomes and treatment responses. Cell Rep Med. 2021;2(12):100478.

12.

Uemura

Kimura

Matsuda

Yamamoto

Sasaki

. Reverse shock index multiplied by Glasgow coma scale score as a point-of-care severity assessment for initial trauma management: a nationwide cohort study. Injury. 2023;13:111267.

13.

Ward

Olafson

Cohen

, et al. Combination of lactate and base deficit levels at admission to predict mortality in blunt trauma patients. Cureus. 2023;15(6):e40097.

14.

de Munter

Polinder

Lansink

KWW

Cnossen

Steyerberg

de Jongh

MAC

. Mortality prediction models in the general trauma population: a systematic review. Injury. 2017;48(2):221-229.

15.

Javali

Krishnamoorthy

Sriharsha

Srinivasarangan

Suraj

. Comparison of injury severity score, new injury severity score, revised trauma score and trauma and injury severity score for mortality prediction in elderly trauma patients. Indian J Crit Care Med. 2019;23(2):73-77.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB

Combined Qualitative Assessment of Admission Shock Index,Base Deficit,and Lactate to Enhance Mortality Predication After Blunt Trauma