MAP-Derived Shock Index for Point-of-Care Physiological Risk Stratification After CT-Confirmed Cervical Spine...

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Emergency Medicine

Background:

• Early mortality risk stratification for cervical spine fractures in major trauma is challenging.
• Standard imaging diagnoses structural injuries but misses physiological deterioration.
• A prognostic model incorporating a novel Shock Index is needed.

Purpose of the Study:

• Develop and validate a prognostic model for in-hospital mortality.
• Evaluate the incremental prognostic value of a Mean Arterial Pressure (MAP)-derived Shock Index.
• Compare the MAP-derived Shock Index against clinical variables and Injury Severity Score (ISS).

Main Methods:

• Retrospective single-center cohort study of 131 adults with CT-confirmed cervical spine fractures and ISS ≥ 15.
• Calculated MAP-derived Shock Index (HR/[1.5 × MAP]).
• Logistic regression models evaluated base clinical, base + MAP-Shock Index, base + ISS, and base + MAP-Shock Index + ISS.

Main Results:

• In-hospital mortality rate was 22.9%.
• The MAP-derived Shock Index model showed high discrimination (AUC 0.91).
• MAP-derived Shock Index provided incremental prognostic information over ISS (AUC 0.82 vs. 0.74).

Conclusions:

• MAP-derived Shock Index complements clinical and ISS assessments for early mortality risk stratification.
• This novel index requires external validation before widespread clinical adoption.
• The study highlights the importance of physiological parameters in trauma prognostication.