Usman Sara, Bhojwani Kamlesh M, Raheem Ahmed, Khan Mehmood A, Khan Nadeem U
Emergency Medicine, Aga Khan University Hospital, Karachi, PAK.
Medicine, Aga Khan University Medical College, Karachi, PAK.
Cureus. 2025 May 2;17(5):e83379. doi: 10.7759/cureus.83379. eCollection 2025 May.
The shock index (SI) and its derivatives, the modified shock index (MSI) and age shock index (ASI), have shown potential as prognostic tools in various clinical settings. However, their utility in predicting outcomes among Emergency Severity Index (ESI) level 3 emergency department (ED) patients remains understudied.
This study aims to evaluate the performance of SI, MSI, and ASI in predicting length of hospital stay (LOS), in-hospital mortality, intensive care unit (ICU) admission, and readmission rates in ESI level 3 ED patients.
This prospective cross-sectional study enrolled 250 ESI level 3 patients from the ED, aged ≥20 years, at a tertiary care hospital in Pakistan, from August 1, 2021, to January 10, 2022. SI, MSI, and ASI were calculated from triage vital signs. Logistic regression analyses assessed associations between the indices and study outcomes. Predictive performance was evaluated using receiver operating characteristic (ROC) curves.
All three indices exhibited significant independent associations with mortality, even after adjusting for confounders (SI ≥1.2, OR: 11.1; MSI ≥1.0, OR: 8.82; ASI ≥36.8, OR: 12.14). ASI remained independently associated with LOS (ASI ≥36.8, OR: 3.23). ROC analyses demonstrated good predictive ability for mortality (AUC 0.84 for SI, 0.82 for ASI) and ICU admission (AUC 0.81 for SI, 0.79 for ASI).
Among ESI level 3 ED patients, SI ≥1.2 demonstrated strong predictive value for mortality, while ASI ≥36.8 showed moderate predictive value and was additionally associated with longer LOS. These indices, particularly the SI and ASI, may be useful adjuncts to clinical assessment for predicting mortality risk in this patient population.
休克指数（SI）及其衍生指标，即改良休克指数（MSI）和年龄休克指数（ASI），已显示出在各种临床环境中作为预后工具的潜力。然而，它们在预测急诊严重程度指数（ESI）3级急诊科患者结局方面的效用仍未得到充分研究。
本研究旨在评估SI、MSI和ASI在预测ESI 3级急诊科患者住院时间（LOS）、院内死亡率、重症监护病房（ICU）入住率和再入院率方面的表现。
这项前瞻性横断面研究于2021年8月1日至2022年1月10日在巴基斯坦一家三级护理医院纳入了250例年龄≥20岁的急诊科ESI 3级患者。根据分诊生命体征计算SI、MSI和ASI。逻辑回归分析评估了这些指标与研究结局之间的关联。使用受试者工作特征（ROC）曲线评估预测性能。
即使在调整混杂因素后，所有三个指标均与死亡率呈现显著的独立关联（SI≥1.2，比值比：11.1；MSI≥1.0，比值比：8.82；ASI≥36.8，比值比：12.14）。ASI与住院时间仍保持独立关联（ASI≥36.8，比值比：3.23）。ROC分析显示对死亡率（SI的AUC为0.84，ASI的AUC为0.82）和ICU入住率（SI的AUC为0.81，ASI的AUC为0.79）具有良好的预测能力。
在ESI 3级急诊科患者中，SI≥1.2对死亡率具有较强的预测价值，而ASI≥36.8显示出中等预测价值，并且还与更长的住院时间相关。这些指标，特别是SI和ASI，可能是临床评估中预测该患者群体死亡风险的有用辅助手段。
