Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

Shao-Chun Wu; Cheng-Shyuan Rau; Spencer C H Kuo; Shiun-Yuan Hsu; Hsiao-Yun Hsieh; Ching-Hua Hsieh

doi:10.1371/journal.pone.0216153

Shock index increase from the field to the emergency room is associated with higher odds of massive transfusion in trauma patients with stable blood pressure: A cross-sectional analysis

PLoS One. 2019 Apr 25;14(4):e0216153. doi: 10.1371/journal.pone.0216153. eCollection 2019.

Authors

Shao-Chun Wu¹, Cheng-Shyuan Rau², Spencer C H Kuo³, Shiun-Yuan Hsu⁴, Hsiao-Yun Hsieh³, Ching-Hua Hsieh³

Affiliations

¹ Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
² Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
³ Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.
⁴ Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan.

Abstract

Background: The shock index (SI) is defined as the ratio of heart rate/systolic blood pressure. This study aimed to determine the performance of delta shock index (ΔSI), a difference between SI upon arrival at the emergency room (ER) and that in the field, in predicting the need for massive transfusion (MT) among adult trauma patients with stable blood pressure.

Methods: This study included registered data from all trauma patients aged 20 years and above who were hospitalized from January 1, 2009 to December 31, 2016. Only patients who were transferred by emergency medical service from the accident site with a systolic blood pressure ≥ 90 mm Hg at the ER were included. The 7,957 enrolled trauma patients were divided into 2 groups, those who had received blood transfusion ≥ 10 U (MT, n = 82) and those who had not (non-MT, n = 7,875). The odds ratios with 95% confidence intervals for the need for MT by a given ΔSI were measured. The plot of specific receiver operating characteristic (ROC) curves was used to evaluate the best cutoff point of ΔSI that could predict the patient's probability of receiving MT.

Results: ROC curve analysis showed that a ΔSI of 0.06 as the cutoff point had the highest AUC of 0.61, with a sensitivity of 0.415 and specificity of 0.841. Patients with a ΔSI ≥ 0.00 had a significant 1.8-fold increase in need for MT than those patients with a ΔSI less than 0.00 (1.4% vs. 0.8%, p = 0.01). The larger the ΔSI, the higher the odds of need for an MT. Using the cutoff point of ΔSI of 0.06, patients with a ΔSI ≥ 0.06 had a significant 3.7-fold increase in need for MT than those patients with a ΔSI less than 0.06 (2.7% vs. 0.7%, p < 0.001).

Conclusions: This study indicated that, in trauma patients with stable blood pressure at the ER, the accuracy of prediction of the requirement for MT by ΔSI is low. However, the size of the delta is significantly associated with need for MT and a lack of improvement in the patient's SI at the ER compared to that in the field significantly increases the odds of a need for MT.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Blood Pressure*
Blood Transfusion*
Cross-Sectional Studies
Emergency Service, Hospital*
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Odds Ratio
ROC Curve
Risk Factors
Shock / complications*
Shock / physiopathology*
Wounds and Injuries / complications*
Wounds and Injuries / physiopathology*

Grants and funding

This research was supported by a grant from Chang Gung Memorial Hospital (CMRPG8G1301) to CHH. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.