Composite shock indices with age, GCS, and SpO2 for trauma triage outcomes: a retrospective cohort study

The study evaluates the effectiveness of composite indices, incorporating age, Glasgow Coma Scale (GCS), and oxygen saturation (SpO2) into shock indices, in predicting severe trauma patient outcomes in the emergency department (ED).

The study was a retrospective, single-center, and cohort-based analysis of adult trauma patients (aged > 18 years) triaged as emergency severity index (ESI) levels 1 or 2 at a level 2 trauma center, conducted over 6 months. Data were collected encompassing vital signs, and composite shock indices from the shock index (SI), reverse shock index (rSI), and modified shock index (MSI) in combination with age, GCS and Spo2.

A study of 437 participants revealed that composite triad-based shock indices such as rSI × SpO2 × GCS/Age, and Age SI/(SpO2 × GCS) significantly influence the differentiation of triage levels 1 and 2. The Age SI/ (SpO2 × GCS) predict in-hospital mortality, while Age MSI/ (SpO2 × GCS), predict blood transfusion necessity. The AUC for triage level discrimination was 1.00 (sensitivity 100%, specificity 100%), for in-hospital mortality 0.77 (sensitivity 69.3%, specificity 80.5%), and for blood transfusion need 0.75 (sensitivity 68.9%, specificity 70.6%).

SI, MSI, and rSI, when combined with age, GCS, and SpO2, are significant predictors of triage level discrimination, in-hospital mortality, and need for blood transfusion, suggesting that composite shock indices are more beneficial than indices alone.