Hamade Bachar, Bayram Jamil D, Hsieh Yu-Hsiang, Khishfe Basem, Al Jalbout Nour
Center for Emergency Medicine, Main Campus and Department of Intensive Care and Resuscitation, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Arch Acad Emerg Med. 2023 Apr 29;11(1):e34. doi: 10.22037/aaem.v11i1.1901. eCollection 2023.
The modified shock index (MSI) is the ratio of heart rate to mean arterial pressure. It is used as a predictive and prognostic marker in a variety of disease states. This study aimed to derive the optimal MSI cut-off that is associated with increased likelihood (likelihood ratio, LR) of admission and in-hospital mortality in patients presenting to emergency department (ED).
We retrospectively reviewed data from the National Hospital Ambulatory Medical Care Survey between 2005 and 2010. Adults>18 years of age were included regardless of chief complaint. Basic patient demographics, initial vital signs, and outcomes were recorded for each patient. Then the optimal MSI cut-off for prediction of admission and in-hospital mortality in ED was calculated. LR ≥ 5 was considered clinically significant.
567,994,402 distinct weighted adult ED patient visits were included in the analysis. 15.7% and 2.4% resulted in admissions and in-hospital mortality, respectively. MSI > 1.7 was associated with a moderate increase in the likelihood of both admission (Positive LR (+LR) = 6.29) and in-hospital mortality (+LR = 5.12). +LR for hospital admission at MSI >1.7 was higher for men (7.13; 95% CI 7.11-7.15) compared to women (5.49; 95% CI 5.47-5.50) and for non-white (7.92; 95% CI 7.88-7.95) compared to white patients (5.85; 95% CI 5.84-5.86). For MSI <0.7, the +LRs were not clinically significant for admission (+LR = 1.07) or in-hospital mortality (LR = 0.75).
In this largest retrospective study, to date, on MSI in the undifferentiated ED population, we demonstrated that an MSI >1.7 on presentation is predictive of admission and in-hospital mortality. The use of MSI could help guide accurate acuity designation, resource allocation, and disposition.
改良休克指数（MSI）是心率与平均动脉压的比值。它在多种疾病状态下用作预测和预后指标。本研究旨在得出与急诊科（ED）就诊患者入院可能性增加（似然比，LR）及院内死亡率相关的最佳MSI临界值。
我们回顾性分析了2005年至2010年期间美国国家医院门诊医疗调查的数据。纳入年龄大于18岁的成年人，无论其主诉如何。记录每位患者的基本人口统计学信息、初始生命体征及结局。然后计算预测急诊科患者入院及院内死亡率的最佳MSI临界值。LR≥5被认为具有临床意义。
分析纳入了567,994,402次不同加权的成年急诊患者就诊记录。分别有15.7%和2.4%的患者导致入院和院内死亡。MSI>1.7与入院可能性（阳性LR（+LR）=6.29）和院内死亡率（+LR=5.12）的适度增加相关。MSI>1.7时，男性入院的+LR（7.13；95%CI 7.11 - 7.15）高于女性（5.49；95%CI 5.47 - 5.50），非白人患者（7.92；95%CI 7.88 - 7.95）高于白人患者（5.85；95%CI 5.84 - 5.86）。对于MSI<0.7，入院（+LR = 1.07）或院内死亡率（LR = 0.75）的+LR在临床上无显著意义。
在这项迄今为止关于未分化急诊人群中MSI的最大规模回顾性研究中，我们证明就诊时MSI>1.7可预测入院及院内死亡率。使用MSI有助于指导准确的病情评估、资源分配和处置。
