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Int. J. Environ. Res. Public Health 2016, 13(4), 357; doi:10.3390/ijerph13040357

Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study

1
Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
2
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
3
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
4
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
Indicates equal contribution in authorship.
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 28 January 2016 / Revised: 21 March 2016 / Accepted: 21 March 2016 / Published: 24 March 2016
View Full-Text   |   Download PDF [522 KB, uploaded 24 March 2016]   |  

Abstract

Background: The ratio of systolic blood pressure (SBP) to heart rate (HR), called the reverse shock index (RSI), is used to evaluate the hemodynamic stability of trauma patients. A SBP lower than the HR (RSI < 1) indicates the probability of hemodynamic shock. The objective of this study was to evaluate whether the RSI as evaluated by emergency medical services (EMS) personnel at the injury scene (EMS RSI) and the physician in the emergency department (ED RSI) could be used as an additional variable to identify patients who are at high risk of more severe injury. Methods: Data obtained from all 16,548 patients added to the trauma registry system at a Level I trauma center between January 2009 and December 2013 were retrospectively reviewed. Only patients transferred by EMS were included in this study. A total of 3715 trauma patients were enrolled and subsequently divided into four groups: group I patients had an EMS RSI ≥1 and an ED RSI ≥1 (n = 3485); group II an EMS RSI ≥ 1 and an ED RSI < 1 (n = 85); group III an EMS RSI < 1 and an ED RSI ≥ 1 (n = 98); and group IV an EMS RSI < 1 and a ED RSI < 1 (n = 47). A Pearson’s χ2 test, Fisher’s exact test, or independent Student’s t-test was conducted to compare trauma patients in groups II, III, and IV with those in group I. Results: Group II and IV patients had a higher injury severity score, a higher incidence of commonly associated injuries, and underwent more procedures (including intubation, chest tube insertion, and blood transfusion in the ED) than patients in group I. Group II and IV patients were also more likely to receive a severe injury to the thoracoabdominal area. These patients also had worse outcomes regarding the length of stay in hospital and intensive care unit (ICU), the proportion of patients admitted to ICU, and in-hospital mortality. Group II patients had a higher adjusted odds ratio for mortality (5.8-times greater) than group I patients. Conclusions: Using an RSI < 1 as a threshold to evaluate the hemodynamic condition of the patients at the injury scene and upon arrival to the ED provides valid information regarding deteriorating outcomes for certain subgroups of patients in the ED setting. Particular attention and additional resources should be provided to patients with an EMS RSI ≥ 1 that deteriorates to an RSI < 1 upon arrival to the ED since a higher odds of mortality was found in these patients. View Full-Text
Keywords: reverse shock index (RSI); shock index (SI); emergency medical services (EMS); injury severity score (ISS); length of stay (LOS); mortality reverse shock index (RSI); shock index (SI); emergency medical services (EMS); injury severity score (ISS); length of stay (LOS); mortality
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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MDPI and ACS Style

Lai, W.-H.; Rau, C.-S.; Hsu, S.-Y.; Wu, S.-C.; Kuo, P.-J.; Hsieh, H.-Y.; Chen, Y.-C.; Hsieh, C.-H. Using the Reverse Shock Index at the Injury Scene and in the Emergency Department to Identify High-Risk Patients: A Cross-Sectional Retrospective Study. Int. J. Environ. Res. Public Health 2016, 13, 357.

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