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Cited by 29Trauma and Emergency Care StudiesTrauma, Hemostasis, Coagulopathy, ResuscitationHemodynamic Monitoring and Therapy

Systolic blood pressure lower than heart rate upon arrival at and departure from the Emergency Department indicates a poor outcome for adult trauma patients

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Lai, Wei-Hung, Wu, Shao-Chun, Rau, Cheng-Shyuan, Kuo, Pao-Jen, Hsu, Shiun-Yuan, Chen, Yi-Chun, Hsieh, Hsiao-Yun, Hsieh, Ching-Hua·2016·International Journal of Environmental Research and Public Health
DOI 10.3390/ijerph13060528PMC PMC4923985
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Abstract

Background: Hemorrhage is a leading cause of preventable trauma death. In this study, we used the reverse shock index (RSI), a ratio of systolic blood pressure (SBP) to heart rate (HR), to evaluate the hemodynamic stability of trauma patients. As an SBP lower than the HR (RSI < 1) may indicate hemodynamic instability, the objective of this study was to assess the associated complications in trauma patients with an RSI < 1 upon arrival at the emergency department (ED) (indicated as (A)RSI) and at the time of departure from the ED (indicated as (L)RSI) to the operative room or for admission. Methods: Data obtained from all 16,548 hospitalized patients recorded in the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. A total of 10,234 adult trauma patients aged ≥20 were enrolled and subsequently divided into four groups: Group I, (A)RSI ≥ 1 and (L)RSI ≥ 1 (n = 9827); Group II, (A)RSI ≥ 1 and (L)RSI < 1 (n = 76); Group III, (A)RSI < 1 and (L)RSI ≥ 1 (n = 251); and Group IV, (A)RSI < 1 and (L)RSI < 1 (n = 80). Pearson’s χ2 test, Fisher’s exact test, or independent Student’s t-test was conducted to compare trauma patients in Groups II, III, and IV with those in Group I. Results: Patients in Groups II, III, and IV had a higher injury severity score and underwent a higher number of procedures, including intubation, chest tube insertion, and blood transfusion, than Group I patients. Additionally, patients of these groups had increased hospital length of stay (16.3 days, 14.9 days, and 22.0 days, respectively), proportion of patients admitted to the intensive care unit (ICU) (48.7%, 43.0%, and 62.5%, respectively), and in-hospital mortality (19.7%, 7.6%, and 27.5%, respectively). Although the trauma patients who had a SBP < 90 mmHg either upon arrival at or departure from the ED also present a more severe injury and poor outcome, those patients who had a SBP ≥ 90 mmHg but an RSI < 1 had a more severe injury and poor outcome than those patients who had a SBP ≥ 90 mmHg and an RSI ≥ 1. Conclusions: SBP lower than heart rate (RSI < 1) either upon arrival at or departure from the ED may indicate a detrimental sign of poor outcome in adult trauma patients even in the absence of noted hypotension.

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  • Patients with a shock index greater than 0.8 are at particular risk of developing significant hypotension in the postintubation period.

    “Patients with a shock index (defined as heart rate divided by SBP) of greater than 0.8 are at particular risk of developing significant hypotension in the postintubation period.82,95,96”

    From Airway Management in Trauma (2018) · cites this paper as [96]

    The Background says shock index is a strong predictor of postintubation hemodynamic instability in the emergency department. It does not give a >0.8 threshold or specify significant postintubation hypotension; the threshold it discusses is ≥1 for an uncompensated shock state. The Conclusions concern poor outcomes in adult trauma patients with a reverse shock index <1, not postintubation hypotension. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Lai, W.-H., Wu, S.-C., Rau, C.-S., Kuo, P.-J., Hsu, S.-Y., Chen, Y.-C., Hsieh, H.-Y., & Hsieh, C.-H.
Affiliations
Chang Gung University (TW)
Corresponding author
Hsieh, Ching-Hua
ORCID
Venue
International Journal of Environmental Research and Public Health
Publisher
MDPI AG
Published
2016-05-25
Volume
13
Issue
6
Pages
528
ISSN
1660-4601 (ISSN-L)
DOI
10.3390/ijerph13060528
PMC
PMC4923985
OpenAlex
W2395080101
Cited by
29
References
0
Citations by year
2026: 3 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 1 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 2
FWCI
4.41
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Chang Gung Memorial Hospital (CDRPG8C0031)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
Keywords
trauma patients, hemorrhagic shock, hemodynamic instability, in-hospital mortality, Injury Severity Score, intensive care unit admission, length of hospital stay, blood transfusion, trauma outcomes, emergency department evaluation, trauma registry data
MeSH terms
Adult, Aged, Blood Pressure, Female, Heart Rate, Humans, Intensive Care Units, Male, Middle Aged, Retrospective Studies, Taiwan, Trauma Centers, Wounds and Injuries, Injury Severity Score, Treatment Outcome, Hospital Mortality, Young Adult

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