Modified shock index and mortality rate of emergency patients

doi:10.5847/wjem.j.issn.1920-8642.2012.02.006

Abstract

Abstract:

BACKGROUND: This study aimed to determine whether modified shock index (MSI) is associated with mortality that is superior to heart rate, blood pressure, or the shock index (SI) in emergency patients.

METHODS: A retrospective database review was performed on 22 161 patients who presented to Peking Union Medical College Hospital Emergency Department and received intravenous fluids from January 1 to December 31, 2009. We gathered data of the patients on age, gender, vital signs, levels of consciousness, presenting complaints, and SI and MSI were calculated for all patients.

RESULTS: Multivariate regression analysis was performed to determine the correlation between risk factors and outcome. There is a significant correlation between emergency patient mortality rate and patient's vital signs obtained at the triage desk (HR>120 beats/min, systolic BP<90 mmHg, diastolic BP<60 mmHg). MSI is a stronger predictor of emergency patient mortality compared to heart rate and blood pressure alone, whereas SI does not have a significant correlation with emergency patient mortality rate.

CONCLUSION: MSI is a clinically significant predictor of mortality in emergency patients. It may be better than using heart rate and blood pressure alone. SI is not significantly correlated with the mortality rate of the emergency patient.

Key words: Emergency department, Modified shock index, Mortality rate, Predictor, Multivariate regression analysis

Ye-cheng Liu, Ji-hai Liu, Zhe Amy Fang, Guang-liang Shan, Jun Xu, Zhi-wei Qi, Hua-dong Zhu, Zhong Wang, Xue-zhong Yu. Modified shock index and mortality rate of emergency patients[J]. World Journal of Emergency Medicine, 2012, 3(2): 114-117.

Figures/Tables 4

Figure 1.

Table 1

Figure 2.

Table 2

References 5

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Variables	Total number of patients (n=22 161)
Age (years)	45±19
Male (%)	41
Heart rate (beats/min)	89±18
Systolic blood pressure (mmHg)	128±26
Diastolic blood pressure (mmHg)	73±15
Pulse oximetry (%)	98±2
Shock index	0.72±0.21
Modified shock index	1.01±0.29
Tachypnea (respiratory rate>30 breaths/min) (%)	8.0
Abdominal pain (%)	18.3
Chest pain (%)	15.7
Altered mental status (%)	14.0
Trauma and hemorrhage (%)	8.4
Headache (%)	3.2
Hospitalization outcomes (%)
ICU admission	4.2
Mortality	1.8

Variables	Odds ratio	95% CI
Heart rate >120	2.6	1.9-3.6
Systolic blood pressure <90	2.6	1.9-3.6
Diastolic blood pressure <60	1.6	1.2-2.1
Modified shock index <0.7	3.7	1.7-7.8
Modified shock index >1.3	4.9	3.6-6.6
Shock index<0.5 or >0.9	1.3 (non-statistical significance)	0.8-1.7

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