Shock index predicts mortality in geriatric trauma patients: An analysis of the National Trauma Data Bank

Viraj Pandit, Peter M Rhee, Ammar Hashmi, Narong Kulvatunyou, Andrew - Tang, Mazhar Khalil, Terence S Okeeffe, Donald Green, Randall S Friese, Bellal A Joseph

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients. Methods: We performed a 4-year (2007-2010) retrospective analysis using the National Trauma Data Bank. Patients 65 years or older were included. Transferred patients, patients dead on arrival, missing vitals on presentation, and patients with burns and traumatic brain injury were excluded. A cutoff value of SI greater than or equal to 1 (sensitivity, 81%; specificity, 79%) was used to define hemodynamic instability. The primary outcome measure was mortality. Secondary outcome measures were need for blood transfusion, need for exploratory laparotomy, and development of in-hospital complications. Multiple logistic regressions were performed. Results: A total of 485,595 geriatric patients were reviewed, of whom 217,190 were included. The mean (SD) age was 77.7 (7.1) years, 60% were males, median Glasgow Coma Scale (GCS) score was 14 (range, 3-15), median Injury Severity Score (ISS) was 9 (range, 4-18), and mean (SD) SI was 0.58 (0.18). Three percent (n = 6,585) had an SI greater than or equal to 1. Patients with SI greater than or equal to 1 were more likely to require blood product requirement (p = 0.001), require an exploratory laparotomy (p = 0.01), and have in-hospital complications (p = 0.02). The overall mortality rate was 4.1% (n = 8,952). SI greater than or equal to 1 was the strongest predictor for mortality (odds ratio, 3.1; 95% confidence interval, 2.6-3.3; p = 0.001) in geriatric trauma patients. Systolic blood pressure (p = 0.09) and heart rate (p = 0.2) were not predictive of mortality. Conclusion: SI is an accurate and specific predictor of morbidity and mortality in geriatric trauma patients. SI is superior to heart rate and systolic blood pressure for predicting mortality in geriatric trauma patients. Geriatric trauma patients with SI greater than or equal to 1 should be transferred to a Level 1 trauma center. LEVEL OF EVIDENCE: Prognostic/ epidemiologic study, level III.

Original languageEnglish (US)
Pages (from-to)1111-1115
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume76
Issue number4
DOIs
StatePublished - 2014

Fingerprint

Geriatrics
Shock
Databases
Mortality
Wounds and Injuries
Blood Pressure
Heart Rate
Laparotomy
Outcome Assessment (Health Care)
Glasgow Coma Scale
Injury Severity Score
Trauma Centers
Burns
Blood Transfusion
Epidemiologic Studies
Logistic Models
Hemodynamics
Odds Ratio
Confidence Intervals
Morbidity

Keywords

  • blood transfusion
  • Geriatric
  • mortality
  • shock index
  • vitals on presentation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Shock index predicts mortality in geriatric trauma patients : An analysis of the National Trauma Data Bank. / Pandit, Viraj; Rhee, Peter M; Hashmi, Ammar; Kulvatunyou, Narong; Tang, Andrew -; Khalil, Mazhar; Okeeffe, Terence S; Green, Donald; Friese, Randall S; Joseph, Bellal A.

In: Journal of Trauma and Acute Care Surgery, Vol. 76, No. 4, 2014, p. 1111-1115.

Research output: Contribution to journalArticle

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abstract = "Background: Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients. Methods: We performed a 4-year (2007-2010) retrospective analysis using the National Trauma Data Bank. Patients 65 years or older were included. Transferred patients, patients dead on arrival, missing vitals on presentation, and patients with burns and traumatic brain injury were excluded. A cutoff value of SI greater than or equal to 1 (sensitivity, 81{\%}; specificity, 79{\%}) was used to define hemodynamic instability. The primary outcome measure was mortality. Secondary outcome measures were need for blood transfusion, need for exploratory laparotomy, and development of in-hospital complications. Multiple logistic regressions were performed. Results: A total of 485,595 geriatric patients were reviewed, of whom 217,190 were included. The mean (SD) age was 77.7 (7.1) years, 60{\%} were males, median Glasgow Coma Scale (GCS) score was 14 (range, 3-15), median Injury Severity Score (ISS) was 9 (range, 4-18), and mean (SD) SI was 0.58 (0.18). Three percent (n = 6,585) had an SI greater than or equal to 1. Patients with SI greater than or equal to 1 were more likely to require blood product requirement (p = 0.001), require an exploratory laparotomy (p = 0.01), and have in-hospital complications (p = 0.02). The overall mortality rate was 4.1{\%} (n = 8,952). SI greater than or equal to 1 was the strongest predictor for mortality (odds ratio, 3.1; 95{\%} confidence interval, 2.6-3.3; p = 0.001) in geriatric trauma patients. Systolic blood pressure (p = 0.09) and heart rate (p = 0.2) were not predictive of mortality. Conclusion: SI is an accurate and specific predictor of morbidity and mortality in geriatric trauma patients. SI is superior to heart rate and systolic blood pressure for predicting mortality in geriatric trauma patients. Geriatric trauma patients with SI greater than or equal to 1 should be transferred to a Level 1 trauma center. LEVEL OF EVIDENCE: Prognostic/ epidemiologic study, level III.",
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T2 - An analysis of the National Trauma Data Bank

AU - Pandit, Viraj

AU - Rhee, Peter M

AU - Hashmi, Ammar

AU - Kulvatunyou, Narong

AU - Tang, Andrew -

AU - Khalil, Mazhar

AU - Okeeffe, Terence S

AU - Green, Donald

AU - Friese, Randall S

AU - Joseph, Bellal A

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N2 - Background: Heart rate and systolic blood pressure are unreliable in geriatric trauma patients. Shock index (SI) (heart rate/systolic blood pressure) is a simple marker of worse outcomes after injury. The aim of this study was to assess the utility of SI in predicting outcomes. We hypothesized that SI predicts mortality in geriatric trauma patients. Methods: We performed a 4-year (2007-2010) retrospective analysis using the National Trauma Data Bank. Patients 65 years or older were included. Transferred patients, patients dead on arrival, missing vitals on presentation, and patients with burns and traumatic brain injury were excluded. A cutoff value of SI greater than or equal to 1 (sensitivity, 81%; specificity, 79%) was used to define hemodynamic instability. The primary outcome measure was mortality. Secondary outcome measures were need for blood transfusion, need for exploratory laparotomy, and development of in-hospital complications. Multiple logistic regressions were performed. Results: A total of 485,595 geriatric patients were reviewed, of whom 217,190 were included. The mean (SD) age was 77.7 (7.1) years, 60% were males, median Glasgow Coma Scale (GCS) score was 14 (range, 3-15), median Injury Severity Score (ISS) was 9 (range, 4-18), and mean (SD) SI was 0.58 (0.18). Three percent (n = 6,585) had an SI greater than or equal to 1. Patients with SI greater than or equal to 1 were more likely to require blood product requirement (p = 0.001), require an exploratory laparotomy (p = 0.01), and have in-hospital complications (p = 0.02). The overall mortality rate was 4.1% (n = 8,952). SI greater than or equal to 1 was the strongest predictor for mortality (odds ratio, 3.1; 95% confidence interval, 2.6-3.3; p = 0.001) in geriatric trauma patients. Systolic blood pressure (p = 0.09) and heart rate (p = 0.2) were not predictive of mortality. Conclusion: SI is an accurate and specific predictor of morbidity and mortality in geriatric trauma patients. SI is superior to heart rate and systolic blood pressure for predicting mortality in geriatric trauma patients. Geriatric trauma patients with SI greater than or equal to 1 should be transferred to a Level 1 trauma center. LEVEL OF EVIDENCE: Prognostic/ epidemiologic study, level III.

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KW - mortality

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KW - vitals on presentation

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