Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug;48(4):2559-2566.
doi: 10.1007/s00068-022-01932-z. Epub 2022 Mar 8.

Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis

Malene Vang  1 , Maria Østberg  2 , Jacob Steinmetz  2   3 , Lars S Rasmussen  2   4
Affiliations
Meta-Analysis

Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis

Malene Vang et al. Eur J Trauma Emerg Surg. 2022 Aug.

Abstract

Purpose: The primary aim was to determine whether a shock index (SI) ≥ 1 in adult trauma patients was associated with increased in-hospital mortality compared to an SI < 1.

Methods: This systematic review including a meta-analysis was performed in accordance with the PRISMA guidelines. EMBASE, MEDLINE, and Cochrane Library were searched, and two authors independently screened articles, performed the data extraction, and assessed risk of bias. Studies were included if they reported in-hospital, 30-day, or 48-h mortality, length of stay, massive blood transfusion or ICU admission in trauma patients with SI recorded at arrival in the emergency department or trauma center. Risk of bias was assessed using the Newcastle-Ottawa Scale, and the strength and quality of the body of evidence according to GRADE. Data were pooled using a random effects model. Inter-rater reliability was assessed with Cohen's kappa.

Results: We screened 1350 citations with an inter-rater reliability of 0.90. Thirty-eight cohort studies were included of which 14 reported the primary outcome. All studies reported a significant higher in-hospital mortality in adult trauma patients with an SI ≥ 1 compared to those having an SI < 1. Twelve studies involving a total of 348,687 participants were included in the meta-analysis. The pooled risk ratio (RR) of in-hospital mortality was 4.15 (95% CI 2.96-5.83). The overall quality of evidence was low.

Conclusions: This systematic review found a fourfold increased risk of in-hospital mortality in adult trauma patients with an initial SI ≥ 1 in the emergency department or trauma center.

Keywords: Emergency department; Massive blood transfusion; Mortality; Shock index; Trauma.

PubMed Disclaimer

References

    1. Geneva WHO. Global Health Estimates 2016: Deaths by Cause, Age, Sex, by Country and by Region, 2000–2016. 2018.
    1. Sobrino J, Shafi S. Timing and causes of death after injuries. Proc (Bayl Univ Med Cent). 2013;26(2):120–3. https://doi.org/10.1080/08998280.2013.11928934 . - DOI
    1. Kauvar DS, Lefering R, Wade CE. Impact of Hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma Acute Care Surg. 2006;60(6):S3–11. - DOI
    1. Pacagnella RC, Souza JP, Durocher J, et al. A systematic review of the relationship between blood loss and clinical signs. PLoS One. 2013;8(3):e57594–e57594. https://doi.org/10.1371/journal.pone.0057594 . - DOI - PubMed - PMC
    1. Frank M, Schmucker U, Stengel D, et al. Proper estimation of blood loss on scene of trauma: tool or tale? J Trauma Acute Care Surg. 2010;69(5):1191–5. - DOI

LinkOut - more resources