Shock Index in the Emergency Department: Utility and Limitations

Overview

Journal Open Access Emerg Med

Publisher Dove Medical Press

Specialty Emergency Medicine

Date 2019 Oct 17

PMID 31616192

Citations 57

Authors

Erica Koch

Shannon Lovett

Trac Nghiem

Robert A Riggs

Megan A Rech

Affiliations

Soon will be listed here.

Abstract

Shock index (SI) is defined as the heart rate (HR) divided by systolic blood pressure (SBP). It has been studied in patients either at risk of or experiencing shock from a variety of causes: trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, and ruptured ectopic pregnancy. While HR and SBP have traditionally been used to characterize shock in these patients, they often appear normal in the compensatory phase of shock and can be confounded by factors such as medications (eg, antihypertensives, beta-agonists). SI >1.0 has been widely found to predict increased risk of mortality and other markers of morbidity, such as need for massive transfusion protocol activation and admission to intensive care units. Recent research has aimed to study the use of SI in patients immediately on arrival to the emergency department (ED). In this review, we summarize the literature pertaining to use of SI across a variety of settings in the management of ED patients, in order to provide context for use of this measure in the triage and management of critically ill patients.

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References

Shippy C, Appel P, Shoemaker W . Reliability of clinical monitoring to assess blood volume in critically ill patients. Crit Care Med. 1984; 12(2):107-12. DOI: 10.1097/00003246-198402000-00005. View

Acker S, Bredbeck B, Partrick D, Kulungowski A, Barnett C, Bensard D . Shock index, pediatric age-adjusted (SIPA) is more accurate than age-adjusted hypotension for trauma team activation. Surgery. 2016; 161(3):803-807. DOI: 10.1016/j.surg.2016.08.050. View

Berger T, Green J, Horeczko T, Hagar Y, Garg N, Suarez A . Shock index and early recognition of sepsis in the emergency department: pilot study. West J Emerg Med. 2013; 14(2):168-74. PMC: 3628475. DOI: 10.5811/westjem.2012.8.11546. View

Jaramillo S, Barnhart K, Takacs P . Use of the shock index to predict ruptured ectopic pregnancies. Int J Gynaecol Obstet. 2010; 112(1):68. DOI: 10.1016/j.ijgo.2010.08.005. View

Torabi M, Mirafzal A, Rastegari A, Sadeghkhani N . Association of triage time Shock Index, Modified Shock Index, and Age Shock Index with mortality in Emergency Severity Index level 2 patients. Am J Emerg Med. 2015; 34(1):63-8. DOI: 10.1016/j.ajem.2015.09.014. View

Sam A, Sanchez D, Gomez V, Wagner C, Kopecna D, Zamarro C . The shock index and the simplified PESI for identification of low-risk patients with acute pulmonary embolism. Eur Respir J. 2010; 37(4):762-6. DOI: 10.1183/09031936.00070110. View

Mutschler M, Nienaber U, Munzberg M, Wolfl C, Schoechl H, Paffrath T . The Shock Index revisited - a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU. Crit Care. 2013; 17(4):R172. PMC: 4057268. DOI: 10.1186/cc12851. View

Haider A, Azim A, Rhee P, Kulvatunyou N, Ibraheem K, Tang A . Substituting systolic blood pressure with shock index in the National Trauma Triage Protocol. J Trauma Acute Care Surg. 2016; 81(6):1136-1141. DOI: 10.1097/TA.0000000000001205. View

Gupta S, Alam A . Shock Index-A Useful Noninvasive Marker Associated With Age-Specific Early Mortality in Children With Severe Sepsis and Septic Shock: Age-Specific Shock Index Cut-Offs. J Intensive Care Med. 2018; 35(10):984-991. DOI: 10.1177/0885066618802779. View

10.

Schroll R, Swift D, Tatum D, Couch S, Heaney J, Llado-Farrulla M . Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury. 2017; 49(1):15-19. DOI: 10.1016/j.injury.2017.09.015. View

11.

Linnaus M, Notrica D, Langlais C, St Peter S, Leys C, Ostlie D . Prospective validation of the shock index pediatric-adjusted (SIPA) in blunt liver and spleen trauma: An ATOMAC+ study. J Pediatr Surg. 2016; 52(2):340-344. DOI: 10.1016/j.jpedsurg.2016.09.060. View

12.

Birkhahn R, Gaeta T, Bei R, Bove J . Shock index in the first trimester of pregnancy and its relationship to ruptured ectopic pregnancy. Acad Emerg Med. 2002; 9(2):115-9. DOI: 10.1111/j.1553-2712.2002.tb00226.x. View

13.

Palmer C . Major trauma and the injury severity score--where should we set the bar?. Annu Proc Assoc Adv Automot Med. 2008; 51:13-29. PMC: 3217501. View

14.

Vandromme M, Griffin R, Kerby J, McGwin Jr G, Rue 3rd L, Weinberg J . Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011; 70(2):384-8. DOI: 10.1097/TA.0b013e3182095a0a. View

15.

Odom S, Howell M, Gupta A, Silva G, Cook C, Talmor D . Extremes of shock index predicts death in trauma patients. J Emerg Trauma Shock. 2016; 9(3):103-6. PMC: 4960776. DOI: 10.4103/0974-2700.185272. View

16.

Sobrino J, Shafi S . Timing and causes of death after injuries. Proc (Bayl Univ Med Cent). 2013; 26(2):120-3. PMC: 3603725. DOI: 10.1080/08998280.2013.11928934. View

17.

Toosi M, Merlino J, Leeper K . Prognostic value of the shock index along with transthoracic echocardiography in risk stratification of patients with acute pulmonary embolism. Am J Cardiol. 2008; 101(5):700-5. DOI: 10.1016/j.amjcard.2007.10.038. View

18.

Birkhahn R, Gaeta T, Van Deusen S, Tloczkowski J . The ability of traditional vital signs and shock index to identify ruptured ectopic pregnancy. Am J Obstet Gynecol. 2003; 189(5):1293-6. DOI: 10.1067/s0002-9378(03)00663-x. View

19.

Zarzaur B, Croce M, Magnotti L, Fabian T . Identifying life-threatening shock in the older injured patient: an analysis of the National Trauma Data Bank. J Trauma. 2010; 68(5):1134-8. DOI: 10.1097/TA.0b013e3181d87488. View

20.

King R, Plewa M, Buderer N, Knotts F . Shock index as a marker for significant injury in trauma patients. Acad Emerg Med. 1996; 3(11):1041-5. DOI: 10.1111/j.1553-2712.1996.tb03351.x. View