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HUNTINGTON BEACH, CALIF. — In patients older than 55 years, multiplying a patient's age by the Shock Index—a ratio of heart rate to systolic blood pressure—provides a better predictor of 48-hour mortality than using the Shock Index alone, Dr. Ben L. Zarzaur said at the Academic Surgical Congress.
The Shock Index has long been known to provide a better predictive rule of thumb than heart rate or blood pressure alone, Dr. Zarzaur said. Better still are several measures such as the Injury Severity Score, the Revised Trauma Score, and the Trauma Injury Severity Score—but they use relatively complex equations and can be difficult to calculate in the resuscitation room.
In contrast, the Shock Index (SI) is simple to calculate but does not take into account the effect of patient age.
Dr. Zarzaur of the Presley Memorial Trauma Center at the University of Tennessee, Memphis, and his colleagues conducted a retrospective cohort study involving 16,077 patients, aged 18–81 years, who were admitted to the trauma center between 1996 and 2005. All were victims of blunt trauma, and all arrived with a palpable pulse of at least 10 beats per minute and a systolic blood pressure of at least 30 mm Hg.
The investigators excluded victims of neurotrauma, those who were admitted more than 24 hours after the injury, and those whose records lacked data on pulse rate and blood pressure.
They divided the patients into two groups: those who were 55 years old or younger and those older than 55 years. The mean age of the younger patients was 34 years and that of the older patients was 67 years.
The primary outcome measure was death within 48 hours, and the investigators used the need for a blood transfusion during that time period as a secondary outcome. They analyzed the area under the receiver operating curve (ROC), a statistical method that quantifies the balance between sensitivity and specificity, to determine which measures were best.
Among the younger patients, SI alone had a significantly larger ROC area than did pulse rate, systolic blood pressure, or age multiplied by SI. An SI score greater than 0.8 successfully predicted significant early mortality and transfusion in this age group.
In the older patients, on the other hand, age multiplied by SI had a larger ROC area than did the other measures. When age was multiplied by SI, a resulting product that was 50 or greater successfully predicted significant early mortality and transfusion in the older patients.
Dr. Zarzaur declared that he had no financial conflicts related to the study.
HUNTINGTON BEACH, CALIF. — In patients older than 55 years, multiplying a patient's age by the Shock Index—a ratio of heart rate to systolic blood pressure—provides a better predictor of 48-hour mortality than using the Shock Index alone, Dr. Ben L. Zarzaur said at the Academic Surgical Congress.
The Shock Index has long been known to provide a better predictive rule of thumb than heart rate or blood pressure alone, Dr. Zarzaur said. Better still are several measures such as the Injury Severity Score, the Revised Trauma Score, and the Trauma Injury Severity Score—but they use relatively complex equations and can be difficult to calculate in the resuscitation room.
In contrast, the Shock Index (SI) is simple to calculate but does not take into account the effect of patient age.
Dr. Zarzaur of the Presley Memorial Trauma Center at the University of Tennessee, Memphis, and his colleagues conducted a retrospective cohort study involving 16,077 patients, aged 18–81 years, who were admitted to the trauma center between 1996 and 2005. All were victims of blunt trauma, and all arrived with a palpable pulse of at least 10 beats per minute and a systolic blood pressure of at least 30 mm Hg.
The investigators excluded victims of neurotrauma, those who were admitted more than 24 hours after the injury, and those whose records lacked data on pulse rate and blood pressure.
They divided the patients into two groups: those who were 55 years old or younger and those older than 55 years. The mean age of the younger patients was 34 years and that of the older patients was 67 years.
The primary outcome measure was death within 48 hours, and the investigators used the need for a blood transfusion during that time period as a secondary outcome. They analyzed the area under the receiver operating curve (ROC), a statistical method that quantifies the balance between sensitivity and specificity, to determine which measures were best.
Among the younger patients, SI alone had a significantly larger ROC area than did pulse rate, systolic blood pressure, or age multiplied by SI. An SI score greater than 0.8 successfully predicted significant early mortality and transfusion in this age group.
In the older patients, on the other hand, age multiplied by SI had a larger ROC area than did the other measures. When age was multiplied by SI, a resulting product that was 50 or greater successfully predicted significant early mortality and transfusion in the older patients.
Dr. Zarzaur declared that he had no financial conflicts related to the study.
HUNTINGTON BEACH, CALIF. — In patients older than 55 years, multiplying a patient's age by the Shock Index—a ratio of heart rate to systolic blood pressure—provides a better predictor of 48-hour mortality than using the Shock Index alone, Dr. Ben L. Zarzaur said at the Academic Surgical Congress.
The Shock Index has long been known to provide a better predictive rule of thumb than heart rate or blood pressure alone, Dr. Zarzaur said. Better still are several measures such as the Injury Severity Score, the Revised Trauma Score, and the Trauma Injury Severity Score—but they use relatively complex equations and can be difficult to calculate in the resuscitation room.
In contrast, the Shock Index (SI) is simple to calculate but does not take into account the effect of patient age.
Dr. Zarzaur of the Presley Memorial Trauma Center at the University of Tennessee, Memphis, and his colleagues conducted a retrospective cohort study involving 16,077 patients, aged 18–81 years, who were admitted to the trauma center between 1996 and 2005. All were victims of blunt trauma, and all arrived with a palpable pulse of at least 10 beats per minute and a systolic blood pressure of at least 30 mm Hg.
The investigators excluded victims of neurotrauma, those who were admitted more than 24 hours after the injury, and those whose records lacked data on pulse rate and blood pressure.
They divided the patients into two groups: those who were 55 years old or younger and those older than 55 years. The mean age of the younger patients was 34 years and that of the older patients was 67 years.
The primary outcome measure was death within 48 hours, and the investigators used the need for a blood transfusion during that time period as a secondary outcome. They analyzed the area under the receiver operating curve (ROC), a statistical method that quantifies the balance between sensitivity and specificity, to determine which measures were best.
Among the younger patients, SI alone had a significantly larger ROC area than did pulse rate, systolic blood pressure, or age multiplied by SI. An SI score greater than 0.8 successfully predicted significant early mortality and transfusion in this age group.
In the older patients, on the other hand, age multiplied by SI had a larger ROC area than did the other measures. When age was multiplied by SI, a resulting product that was 50 or greater successfully predicted significant early mortality and transfusion in the older patients.
Dr. Zarzaur declared that he had no financial conflicts related to the study.