Cho Young Mo, Park Sungwook
Department of Emergency Medicine, Pusan National University Hospital, 179, Gudeok-ro, Seo-Gu, Busan 49241, Republic of Korea.
J Clin Med. 2025 Apr 1;14(7):2416. doi: 10.3390/jcm14072416.
In trauma, the shock index (SI) is commonly used to assess the presence of significant blood loss. Prior studies have shown that the SI has a fair predictive ability for clinical outcomes such as massive transfusion (MT) or mortality in adult trauma patients. We hypothesized that the relatively lower predictive power of the SI in older adult patients compared to that of younger adult patients results in the overall fair predictive ability of the SI for clinical outcomes in adult trauma patients. This retrospective observational study analyzed adult trauma patients who presented to a single regional trauma center between 2019 and 2023, categorizing them into younger (18-64 years) and older (≥65 years) cohorts. The association between SI and MT was evaluated using simple logistic regression, while the modifying effect of age on this association was evaluated through an interaction model. The predictive performance was compared between the groups using the area under the receiver operating characteristic curve (AUC). Age-stratified AUC trends were visualized using cubic spline analysis. A total of 2404 trauma patients met the inclusion criteria, including 1531 younger adults and 873 older adults. The SI was identified as an independent predictor of MT, with a stronger association in younger adults. The AUC for predicting MT was significantly higher in younger adults compared to older adults (0.801 vs. 0.666; < 0.001), with optimal SI cut-off values of 1.18 and 0.88, respectively. Age-stratified analysis showed the highest AUC in the 41-50 age group (AUC 0.880; 95% CI, 0.836-0.916) and the lowest in the 71-80 age group (AUC 0.624; 95% CI, 0.573-0.674). The predictive performance of the SI for MT was influenced by age, demonstrating a lower predictive ability in older adult patients compared to younger adults.
在创伤情况下，休克指数（SI）通常用于评估是否存在大量失血。先前的研究表明，SI对成年创伤患者的临床结局，如大量输血（MT）或死亡率，具有一定的预测能力。我们推测，与年轻成年患者相比，SI在老年成年患者中的预测能力相对较低，这导致了SI对成年创伤患者临床结局的总体预测能力一般。这项回顾性观察研究分析了2019年至2023年间在单一区域创伤中心就诊的成年创伤患者，将他们分为年轻（18 - 64岁）和老年（≥65岁）队列。使用简单逻辑回归评估SI与MT之间的关联，同时通过交互模型评估年龄对该关联的修正作用。使用受试者操作特征曲线下面积（AUC）比较两组之间的预测性能。使用三次样条分析可视化年龄分层的AUC趋势。共有2404名创伤患者符合纳入标准，包括1531名年轻成年人和873名老年成年人。SI被确定为MT的独立预测因子，在年轻成年人中关联更强。与老年成年人相比，年轻成年人预测MT的AUC显著更高（0.801对0.666；<0.001），最佳SI临界值分别为1.18和0.88。年龄分层分析显示，41 - 50岁年龄组的AUC最高（AUC 0.880；95%CI，0.836 - 0.916），71 - 80岁年龄组的AUC最低（AUC 0.624；95%CI，0.573 - 0.674）。SI对MT的预测性能受年龄影响，与年轻成年人相比，老年成年患者的预测能力较低。
