Walker Philip W, Luther James F, Wisniewski Stephen R, Brown Joshua B, Moore Ernest E, Schreiber Martin, Joseph Bellal, Wilson Chad T, Harbrecht Brian G, Ostermayer Daniel G, Cotton Bryan, Miller Richard, Patel Mayur, Martin-Gill Christian, Sperry Jason L, Guyette Francis X
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
Prehosp Emerg Care. 2024 Nov 4:1-7. doi: 10.1080/10903127.2024.2412841.
The delta shock index (ΔSI), defined as the change in shock index (SI) over time, is associated with hospital morbidity and mortality, but prehospital studies about ΔSI are limited. We investigate the association of prehospital ΔSI with mortality and resource utilization, hypothesizing that increases in SI among field trauma patients are associated with increased mortality and blood product transfusion.
We performed a multicenter, retrospective, observational study from the Linking Investigators in Trauma and Emergency Services (LITES) network. We obtained data from January 2017 to June 2021. We fit logistic regression models to evaluate the association between an increase ΔSI > 0.1 and 28-day mortality and blood product transfusion within 4 h of emergency department (ED) arrival. We used negative binomial models to evaluate the association between ΔSI > 0.1 and days in hospital, intensive care unit (ICU), and on ventilator (up to 28 days).
We identified 33,219 prehospital patients. We excluded burn patients and those without documented prehospital or ED heart rate or blood pressure, resulting in 30,511 cases for analysis. In adjusted analysis for the primary outcome of 28-day mortality, patients who had a ΔSI > 0.1 based on initial vital signs were 31% more likely to die (adjusted odds ratio (AOR) of 1.31, 95% CI 1.21-1.41) compared to those patients who had a ΔSI ≤0.1. These patients also spent 16% more days in hospital (adjusted incident rate ratio (AIRR) 1.16, 95% CI 1.14-1.19), 34% more days in ICU (AIRR 1.34, 95% CI 1.28-1.41), and 61% more days on ventilator (ARR 1.61, 95% CI 1.47-1.75). Additionally, patients with a ΔSI > 0.1 had higher odds of receiving blood products (AOR 2.00, 95% CI 1.88-2.12) within 4 h of ED arrival. Models fit excluding hypotensive patients performed similarly.
An increase of greater than 0.1 in the ΔSI was associated with increased 28-day mortality; increased days in hospital, in ICU, and on ventilator; and increased need for blood product transfusion within 4 h of ED arrival. This association held true for initially normotensive patients. Validation and implementation are needed to incorporate ΔSI into prehospital and ED triage.
δ休克指数（ΔSI）定义为休克指数（SI）随时间的变化，与医院发病率和死亡率相关，但关于ΔSI的院前研究有限。我们调查院前ΔSI与死亡率和资源利用之间的关联，假设现场创伤患者SI的增加与死亡率增加和血液制品输注有关。
我们在创伤与急诊服务联系研究者（LITES）网络中进行了一项多中心、回顾性、观察性研究。我们获取了2017年1月至2021年6月的数据。我们拟合逻辑回归模型，以评估ΔSI>0.1的增加与急诊科（ED）就诊后4小时内28天死亡率和血液制品输注之间的关联。我们使用负二项式模型评估ΔSI>0.1与住院天数、重症监护病房（ICU）天数和使用呼吸机天数（最长28天）之间的关联。
我们确定了33219例院前患者。我们排除了烧伤患者以及那些没有记录院前或ED心率或血压的患者，最终有30511例病例用于分析。在对28天死亡率这一主要结局的校正分析中，基于初始生命体征ΔSI>0.1的患者死亡可能性比ΔSI≤0.1的患者高31%（校正比值比（AOR）为1.31，95%置信区间1.21 - 1.41）。这些患者住院天数也多16%（校正发病率比（AIRR）1.16，95%置信区间1.14 - 1.19），在ICU的天数多34%（AIRR 1.34，95%置信区间1.28 - 1.41），使用呼吸机的天数多61%（ARR 1.61，95%置信区间1.47 - 1.75）。此外，ΔSI>0.1的患者在ED就诊后4小时内接受血液制品的几率更高（AOR 2.00，95%置信区间1.88 - 2.12）。排除低血压患者后拟合的模型表现相似。
ΔSI增加大于0.1与28天死亡率增加、住院天数增加、在ICU天数增加和使用呼吸机天数增加以及ED就诊后4小时内血液制品输注需求增加相关。这种关联在最初血压正常的患者中也成立。需要进行验证和实施，以便将ΔSI纳入院前和ED分诊。
