Review article: Shock Index for prediction of critical bleeding post‐trauma: A systematic review

@article{Olaussen2014ReviewAS,
  title={Review article: Shock Index for prediction of critical bleeding post‐trauma: A systematic review},
  author={A. Olaussen and Todd Blackburn and B. Mitra and M. Fitzgerald},
  journal={Emergency Medicine Australasia},
  year={2014},
  volume={26}
}
Early diagnosis of haemorrhagic shock (HS) might be difficult because of compensatory mechanisms. Clinical scoring systems aimed at predicting transfusion needs might assist in early identification of patients with HS. The Shock Index (SI) – defined as heart rate divided by systolic BP – has been proposed as a simple tool to identify patients with HS. This systematic review discusses the SI's utility post‐trauma in predicting critical bleeding (CB). We searched the databases MEDLINE, Embase… Expand
Prediction of critical haemorrhage following trauma: A narrative review
TLDR
A review of the various available models for predicting critical bleeding and massive transfusion in patients with traumatic haemorrhagic shock found that the most superior model performed with variable predictive abilities. Expand
Prediction of massive bleeding. Shock index and modified shock index.
TLDR
Shock index and modified shock index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma. Expand
Massive transfusion in critical haemorrhage following trauma: Aren't we missing something?
TLDR
Defining critical haemorrhage with MT does not properly consider the other crucial components of DCR (DCS and correction of EACT) which are as important as RBC transfusion, so the authors’ opinion about choosingMT as the focused outcome variable is sought. Expand
Prognostic Role of Shock Index in Traumatic Pelvic Fracture: A Retrospective Analysis.
TLDR
SI is a potentially useful instant tool for the prediction of massive transfusion and mortality in patients with TPF and it was found that high SI was an independent predictor of blood transfusions and mortality. Expand
A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting.
TLDR
BD appears superior to vital signs in the immediate physiological assessment of penetrating trauma patients and the use of BD to assess physiological status may help refine their early triage, investigation and management. Expand
Shock Index Predicts Outcome in Patients with Suspected Sepsis or Community-Acquired Pneumonia: A Systematic Review
TLDR
Elevated shock index at time of hospital presentation predicts mortality in sepsis with high specificity and low sensitivity, and may offer benefits over existing sepsi scoring systems due to its simplicity. Expand
The use of the Shock Index as a predictor of active bleeding in trauma patients.
TLDR
An SI cut-off point ≤0.8 is more sensitive than ≥0.9 and allows for earlier initiation of resuscitation maneuvers in patients with occult active bleeding, providing for early initiation of therapeutic maneuvers. Expand
Massive transfusion prediction with inclusion of the pre-hospital Shock Index.
TLDR
The initial pre-hospital SI is associated with MT, however, this relationship did not clinically augment MT decision when combined with the in-hospitalSI, and the simplicity of the SI makes it a favourable option to explore further. Expand
The use of the Shock Index as a predictor of active bleeding in trauma patients.
TLDR
An SI cut-off point of≥0.8 is more sensitive than≤0.9 and allows for earlier initiation of resuscitation maneuvers in patients with occult active bleeding, providing for early initiation of therapeutic maneuvers. Expand
Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients.
TLDR
PreSI and preMSI showed moderate accuracy in predicting massive transfusion (MT) and hospital mortality among trauma patients and did not have higher predictive power than preSI, while in predicting hospital mortality, pre MSI was not superior to preSI. Expand
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References

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TLDR
The optimal SI threshold performed similarly to the optimal threshold HR or SBP for prediction of injury severity, and predicted between 24% fewer cases and 4% more cases of poor outcome than did the optimal thresholds HR and SBP. Expand
The Shock Index revisited – a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU®
TLDR
SI upon emergency department arrival may be considered a clinical indicator of hypovolemic shock in respect to transfusion requirements, hemostatic resuscitation and mortality and the four SI groups have been shown to equal the recently suggested BD-based classification. Expand
Utility of the shock index in predicting mortality in traumatically injured patients.
TLDR
The SI may be a valuable addition to other ED triage criteria currently used to activate trauma team responses as a simple and early marker to predict mortality in traumatically injured patients. Expand
Application of the Shock Index to the prediction of need for hemostasis intervention.
TLDR
SI, at a lowered threshold of ≥0.8, can be used to identify trauma patients that will require intervention for hemostasis, and is more specific in the older patients. Expand
The utility of shock index in differentiating major from minor injury
TLDR
The SI can be a valuable tool, raising suspicion when it is abnormal even when other parameters are not, but is far too insensitive for use as a screening device to rule out disease. Expand
The utility of a shock index ≥ 1 as an indication for pre-hospital oxygen carrier administration in major trauma.
TLDR
The efficacy of pre-hospital intravenous oxygen carriers should be trialled using a shock index ≥ 1.0 despite fluid resuscitation as the clinical trigger for administration. Expand
A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department.
TLDR
The SI may be useful to evaluate acute critical illness in the ED with apparently stable vital signs and an abnormal elevation of the SI to more than 0.9 was associated with an illness that was treated immediately, admission to the hospital, and intensive therapy on admission. Expand
Calculation of Different Triage Scores Based on the German Trauma Registry
TLDR
In the current population, the value of the SI as a field screening tool was better in patients who died of shock and those who sustained abdominal or pelvic injuries when compared with those who had extremity fractures only. Expand
The definition of massive transfusion in trauma: a critical variable in examining evidence for resuscitation
TLDR
There seems to be an increase in mortality with fresh frozen plasma:PRBC ratio of 1 : 1 ratio compared with a 1 : 2 ratio, which further excludes patients who die early. Expand
Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index.
TLDR
Prehospital SI>0.9 identifies patients at risk for MT who would otherwise be considered relatively normotensive under current prehospital triage protocols, and the risk forMT rises substantially with elevation of SI above this level. Expand
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