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The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data

Author

Listed:
  • Shao-Chun Wu

    (Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan
    These authors contribute equally to this paper.)

  • Cheng-Shyuan Rau

    (Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan
    These authors contribute equally to this paper.)

  • Spencer C. H. Kuo

    (Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan)

  • Peng-Chen Chien

    (Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan)

  • Hsiao-Yun Hsieh

    (Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan)

  • Ching-Hua Hsieh

    (Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung 83301, Taiwan)

Abstract

The reverse shock index (rSI) multiplied by Glasgow Coma Scale (GCS) score (rSIG), calculated by multiplying the GCS score with systolic blood pressure (SBP)/hear rate (HR), was proposed to be a reliable triage tool for identifying risk of in-hospital mortality in trauma patients. This study was designed to externally validate the accuracy of the rSIG in the prediction of mortality in our cohort of trauma patients, in comparison with those that were predicted by the Revised Trauma Score (RTS), shock index (SI), and Trauma and Injury Severity Score (TRISS). Adult trauma patients aged ≥20 years who were admitted to the hospital from 1 January 2009 to 31 December 2017, were included in this study. The rSIG, RTS, and SI were calculated according to the initial vital signs and GCS scores of patients upon arrival at the emergency department (ED). The end-point of primary outcome is in-hospital mortality. Discriminative power of each score to predict mortality was measured using area under the curve (AUC) by plotting the receiver operating characteristic (ROC) curve for 18,750 adult trauma patients, comprising 2438 patients with isolated head injury (only head Abbreviated Injury Scale (AIS) ≥ 2) and 16,312 without head injury (head AIS ≤ 1). The predictive accuracy of rSIG was significantly lower than that of RTS in all trauma patients (AUC 0.83 vs. AUC 0.85, p = 0.02) and in patients with isolated head injury (AUC 0.82 vs. AUC 0.85, p = 0.02). For patients without head injury, no difference was observed in the predictive accuracy between rSIG and RTS (AUC 0.83 vs. AUC 0.83, p = 0.97). Based on the cutoff value of 14.0, the rSIG can predict the probability of dying in trauma patients without head injury with a sensitivity of 61.5% and specificity of 94.5%. The predictive accuracy of both rSIG and RTS is significantly poorer than that of TRISS, in all trauma patients (AUC 0.93) or in patients with (AUC 0.89) and without head injury (AUC 0.92). In addition, SI had the significantly worse predictive accuracy than all of the other three models in all trauma patients (AUC 0.57), and the patients with (AUC 0.53) or without (AUC 0.63) head injury. This study revealed that rSIG had a significantly higher predictive accuracy of mortality than SI in all of the studied population but a lower predictive accuracy of mortality than RTS in all adult trauma patients and in adult patients with isolated head injury. In addition, in the adult patients without head injury, rSIG had a similar performance as RTS to the predictive risk of mortality of the patients.

Suggested Citation

  • Shao-Chun Wu & Cheng-Shyuan Rau & Spencer C. H. Kuo & Peng-Chen Chien & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2018. "The Reverse Shock Index Multiplied by Glasgow Coma Scale Score (rSIG) and Prediction of Mortality Outcome in Adult Trauma Patients: A Cross-Sectional Analysis Based on Registered Trauma Data," IJERPH, MDPI, vol. 15(11), pages 1-12, October.
  • Handle: RePEc:gam:jijerp:v:15:y:2018:i:11:p:2346-:d:177932
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    References listed on IDEAS

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    1. Wei-Hung Lai & Cheng-Shyuan Rau & Shiun-Yuan Hsu & Shao-Chun Wu & Pao-Jen Kuo & Hsiao-Yun Hsieh & Yi-Chun Chen & Ching-Hua Hsieh, 2016. "Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study," IJERPH, MDPI, vol. 13(4), pages 1-12, March.
    2. Wei-Hung Lai & Shao-Chun Wu & Cheng-Shyuan Rau & Pao-Jen Kuo & Shiun-Yuan Hsu & Yi-Chun Chen & Hsiao-Yun Hsieh & Ching-Hua Hsieh, 2016. "Systolic Blood Pressure Lower than Heart Rate upon Arrival at and Departure from the Emergency Department Indicates a Poor Outcome for Adult Trauma Patients," IJERPH, MDPI, vol. 13(6), pages 1-18, May.
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    1. Patryk Rzońca & Stanisław Paweł Świeżewski & Rakesh Jalali & Joanna Gotlib & Robert Gałązkowski, 2019. "Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study," IJERPH, MDPI, vol. 16(9), pages 1-12, April.
    2. Fang-Yu Hsu & Shih-Hsuan Mao & Andy Deng-Chi Chuang & Yon-Cheong Wong & Chih-Hao Chen, 2021. "Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding," IJERPH, MDPI, vol. 18(21), pages 1-12, October.
    3. Shiun-Yuan Hsu & Shao-Chun Wu & Cheng-Shyuan Rau & Ting-Min Hsieh & Hang-Tsung Liu & Chun-Ying Huang & Sheng-En Chou & Wei-Ti Su & Ching-Hua Hsieh, 2019. "Impact of Adapting the Abbreviated Injury Scale (AIS)-2005 from AIS-1998 on Injury Severity Scores and Clinical Outcome," IJERPH, MDPI, vol. 16(24), pages 1-10, December.

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