Association of triage time Shock Index, Modified Shock Index, and Age Shock Index with mortality in Emergency Severity Index level 2 patients

Shock Index (SI) is considered to be a predictor of mortality in many medical and trauma settings. Many studies have shown its superiority to conventional vital sign measurements in mortality prediction.

The objectives were to compare mortality and intensive care unit admission prediction of triage time SI, Modified SI (MSI), and Age SI with each other and with triage time blood pressure in Emergency Severity Index (ESI) level 2 patients.

A retrospective medical record review was performed in the internal medicine emergency department of a general hospital in Kerman, Iran. Triage time vital signs were used to calculate the indices. Multivarible regression analysis was used to create the final model.

A total of 1285 patients triaged to ESI level 2 were enrolled in the study. In the multivariate analysis, SI, MSI, and Age SI were found to be the only variables independently associated with mortality, whereas none of them were associated with intensive care unit admission. Sensitivity, specificity, and area under curve in the receiver operating characteristic curve for the model including SI, MSI, and Age SI were 60.8%, 65.4%, and 0.675, respectively. Sensitivity, specificity, and area under curve did not change significantly by excluding SI, MSI, or Age SI from the final model.

In nontrauma adult patients, triage time SI, MSI, and Age SI are superior to blood pressure for mortality prediction in ESI level 2. They can be used alone or in combination with similar results, but their low sensitivity and specificity make them usable only as an adjunct for this purpose.