Witting M D, Smithline H A
University of Maryland Medical Center, Division of Emergency Medicine, Baltimore 21201, USA.
Acad Emerg Med. 1996 Oct;3(10):926-31. doi: 10.1111/j.1553-2712.1996.tb03321.x.
To determine whether the orthostatic change in the shock index or published tilt test criteria better discriminated normal individuals from those with moderate acute blood loss.
Postural vital signs were recorded in a standardized manner before and after an elective 450-mL phlebotomy associated with blood donation in healthy volunteers. Paired comparisons of the sensitivity of each of 3 published tilt test criteria were made against the sensitivity of an orthostatic change in shock index (OCSI) at the threshold for OCSI yielding the same specificity. Subjects were prospectively divided into group 1 (age < 65 years) and group 2 (age > or = 65 years).
A total of 336 healthy euvolemic adult blood donors were studied over a 1-year period (group 1 = 292; group 2 = 44). For each published criterion for a positive tilt test (for both groups), OCSI had the same or higher sensitivity for a chosen specificity. No sensitivity difference was statistically significant. An OCSI > or = 0 was 99%/98% sensitive and 10%/10% specific (group 1/group 2) for a 450-mL blood loss; whereas an OCSI > or = 0.25 was 28%/23% sensitive and 92%/100% specific (group 1/group 2).
The OCSI discriminates normal individuals from those with acute moderate blood loss as well as previously published tilt test definitions do.
确定休克指数的直立位变化或已发表的倾斜试验标准能否更好地区分正常个体与中度急性失血患者。
对健康志愿者进行择期450毫升献血相关的放血操作，以标准化方式记录放血前后的体位生命体征。将3种已发表的倾斜试验标准的敏感性与休克指数直立位变化（OCSI）在产生相同特异性的阈值时的敏感性进行配对比较。受试者前瞻性地分为1组（年龄<65岁）和2组（年龄≥65岁）。
在1年的时间里共研究了336名健康的血容量正常的成年献血者（1组=292人；2组=44人）。对于每种已发表的倾斜试验阳性标准（两组均适用），OCSI在选定的特异性方面具有相同或更高的敏感性。敏感性差异无统计学意义。对于450毫升失血，OCSI≥0的敏感性为99%/98%，特异性为10%/10%（1组/2组）；而OCSI≥0.25的敏感性为28%/23%，特异性为92%/100%（1组/2组）。
OCSI区分正常个体与急性中度失血个体的能力与先前发表的倾斜试验定义相当。
