Department of Anesthesia and Trauma Centre, Centre of Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Danish Air Ambulance, Aarhus, Denmark.
Eur J Trauma Emerg Surg. 2022 Aug;48(4):2559-2566. doi: 10.1007/s00068-022-01932-z. Epub 2022 Mar 8.
The primary aim was to determine whether a shock index (SI) ≥ 1 in adult trauma patients was associated with increased in-hospital mortality compared to an SI < 1.
This systematic review including a meta-analysis was performed in accordance with the PRISMA guidelines. EMBASE, MEDLINE, and Cochrane Library were searched, and two authors independently screened articles, performed the data extraction, and assessed risk of bias. Studies were included if they reported in-hospital, 30-day, or 48-h mortality, length of stay, massive blood transfusion or ICU admission in trauma patients with SI recorded at arrival in the emergency department or trauma center. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the strength and quality of the body of evidence according to GRADE. Data were pooled using a random effects model. Inter-rater reliability was assessed with Cohen's kappa.
We screened 1350 citations with an inter-rater reliability of 0.90. Thirty-eight cohort studies were included of which 14 reported the primary outcome. All studies reported a significant higher in-hospital mortality in adult trauma patients with an SI ≥ 1 compared to those having an SI < 1. Twelve studies involving a total of 348,687 participants were included in the meta-analysis. The pooled risk ratio (RR) of in-hospital mortality was 4.15 (95% CI 2.96-5.83). The overall quality of evidence was low.
This systematic review found a fourfold increased risk of in-hospital mortality in adult trauma patients with an initial SI ≥ 1 in the emergency department or trauma center.
本研究旨在确定成人创伤患者的休克指数（SI）≥1 是否与院内死亡率增加相关，与 SI＜1 的患者相比。
本系统评价包括荟萃分析，符合 PRISMA 指南。检索 EMBASE、MEDLINE 和 Cochrane 图书馆，并由两名作者独立筛选文章、进行数据提取和评估偏倚风险。如果研究报告了创伤患者在急诊科或创伤中心到达时记录的 SI 与院内、30 天或 48 小时死亡率、住院时间、大量输血或 ICU 入院相关，且报告了住院、30 天或 48 小时死亡率、住院时间、大量输血或 ICU 入院，则将其纳入研究。使用纽卡斯尔-渥太华量表评估偏倚风险，并根据 GRADE 评估证据体的强度和质量。使用随机效应模型汇总数据。使用 Cohen's kappa 评估组间可靠性。
我们筛选了 1350 条引用文献，组间可靠性为 0.90。纳入了 38 项队列研究，其中 14 项报告了主要结局。所有研究均报告称，SI≥1 的成人创伤患者的院内死亡率明显高于 SI＜1 的患者。共有 12 项研究共纳入 348687 名参与者，纳入荟萃分析。院内死亡率的汇总风险比（RR）为 4.15（95%CI 2.96-5.83）。总体证据质量低。
本系统评价发现，在急诊科或创伤中心就诊的成人创伤患者中，初始 SI≥1 患者的院内死亡率增加了四倍。
