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Delta shock index predicts injury severity, interventions, and outcomes in trauma patients: A 10-year retrospective
Mohammad Asim1, Ayman El-Menyar1,2, Khalid Ahmed3
1Department of Surgery, Trauma and Vascular Surgery Section, Clinical Research, Hamad Medical Corporation, Doha 3050, Qatar.
Insights
The delta shock index (DSI) effectively predicts severe injuries and mortality in young male trauma patients. A high DSI indicates a greater need for interventions and a worse prognosis, serving as a simple bedside tool.
Area of Science:
- Trauma care
- Emergency medicine
- Clinical assessment
Background:
- Trauma predominantly affects young males in Qatar.
- The delta shock index (DSI) measures the change in shock index from scene to emergency unit admission.
- This study evaluates DSI's predictive value in a Level 1 trauma center.
Purpose of the Study:
- To determine if a high DSI correlates with severe injuries.
- To assess the association between high DSI and increased interventions (e.g., blood transfusion, laparotomy).
- To investigate the link between high DSI and adverse outcomes, including mortality.
Main Methods:
- Retrospective analysis of 13,212 trauma patients from 2011-2021.
- Patients categorized into low (≤0.1) and high (>0.1) DSI groups.
- Correlation and logistic regression analyses used to assess DSI's relationship with injury severity scores, interventions, and mortality.
Main Results:
- 24% of patients had a high DSI; 91% were male.
- High DSI correlated significantly with injury severity scores (ISS, RTS, TRISS, GCS) and outcomes (NTBU, HLOS).
- High DSI was associated with higher rates of intubation, laparotomy, VAP, massive transfusion, and mortality; it independently predicted mortality (OR=1.9).
Conclusions:
- A high DSI is prevalent in young male trauma patients.
- DSI is a practical, simple bedside tool for trauma triage and prognosis.
- DSI offers a rapid assessment, correlating with established injury severity scores and predicting mortality.
Background:
Most trauma occurs among young male subjects in Qatar. We examined the predictive values of the delta shock index (DSI), defined as the change in the shock index (SI) value from the scene to the initial reading in the emergency unit (i.e., subtracting the calculated SI at admission from SI at the scene), at a Level 1 trauma center.
Aim:
To explore whether high DSI is associated with severe injuries, more interventions, and worse outcomes [i.e., blood transfusion, exploratory laparotomy, ventilator-associated pneumonia, hospital length of stay (HLOS), and in-hospital mortality] in trauma patients.
Methods:
A retrospective analysis was conducted after data were extracted from the National Trauma Registry between 2011 and 2021. Patients were grouped based on DSI as low (≤ 0.1) or high (> 0.1). Data were analyzed and compared using χ 2 and Student's t-tests. Correlations between DSI and injury severity score (ISS), revised trauma score (RTS), abbreviated injury scale (AIS), Glasgow coma scale (GCS), trauma score-ISS (TRISS), HLOS, and number of transfused blood units (NTBU), were assessed using correlation coefficient analysis. The diagnostic testing accuracy for predicting mortality was determined using the validity measures of the DSI. Logistic regression analysis was performed to identify predictors of mortality.
Results:
This analysis included 13212 patients with a mean age of 33 ± 14 years, and 24% had a high DSI. Males accounted for 91% of the study population. The trauma activation level was higher in patients with a high DSI (38% vs 15%, P = 0.001). DSI correlated with RTS (r = -0.30), TRISS (r = -0.30), NTBU (r = 0.20), GCS (r = -0.24), ISS (r = 0.22), and HLOS (r = 0.14) (P = 0.001 for all). High DSI was associated with significantly higher rates of intubation, laparotomy, ventilator-associated pneumonia, massive transfusion activation, and mortality than low DSI. For mortality prediction, a high DSI had better specificity, negative predictive value, and negative likelihood ratio (77%, 99%, and 0.49%, respectively). After adjusting for age, emergency medical services time, GCS score, and ISS, multivariable regression analysis showed that DSI was an independent predictor of mortality (odds ratio = 1.9; 95% confidence interval: 1.35-2.76).
Conclusion:
In addition to sex-biased observations, almost one-quarter of the study cohort had a higher DSI and were mostly young. High DSI correlated significantly with the other injury severity scores, which require more time and imaging to be ready to use. Therefore, DSI is a practical, simple bedside tool for triaging and prognosis in young patients with trauma.
