Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury—an analysis of the TraumaRegister DGU®Reportar como inadecuado

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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

, 24:148

First Online: 12 December 2016Received: 27 July 2016Accepted: 30 November 2016


BackgroundA new classification of hypovolemic shock based on the shock index SI was proposed in 2013. This classification contains four classes of shock and shows good correlation with acidosis, blood product need and mortality. Since their applicability was questioned, the aim of this study was to verify the validity of the new classification in multiple injured patients with traumatic brain injury.

MethodsBetween 2002 and 2013, data from 40 888 patients from the TraumaRegister DGU were analysed. Patients were classified according to their initial SI at hospital admission Class I: SI < 0.6, class II: SI ≥0.6 to <1.0, class III SI ≥1.0 to <1.4, class IV: SI ≥1.4. Patients with an additional severe TBI AIS ≥ 3 were compared to patients without severe TBI.

Results16,760 multiple injured patients with TBI AIShead ≥3 were compared to 24,128 patients without severe TBI. With worsening of SI class, mortality rate increased from 20 to 53% in TBI patients. Worsening SI classes were associated with decreased haemoglobin, platelet counts and Quick’s values. The number of blood units transfused correlated with worsening of SI. Massive transfusion rates increased from 3% in class I to 46% in class IV. The accuracy for predicting transfusion requirements did not differ between TBI and Non TBI patients.

DiscussionThe use of the SI based classification enables a quick assessment of patients in hypovolemic shock based on universally available parameters. Although the pathophysiology in TBI and Non TBI patients and early treatment methods such as the use of vasopressors differ, both groups showed an identical probability of recieving blood products within the respective SI class.

ConclusionRegardless of the presence of TBI, the classification of hypovolemic shock based on the SI enables a fast and reliable assessment of hypovolemic shock in the emergency department. Therefore, the presented study supports the SI as a feasible tool to assess patients at risk for blood product transfusions, even in the presence of severe TBI.

KeywordsHaemorrhagic shock Shock index Traumatic brain injury Multiple trauma Abbreviations95% CI95% confidence interval

AISAbbreviated injury scale

ATLSAdvanced trauma life support

AUROCArea under the receiving operating characteristics curve

EDEmergency Department

GCSGlasgow coma scale

HRHeart rate

ICUIntensive care unit

INRInternational normalized ratio

ISSInjury severity score

LOSLength of stay

MOFMultiple organ failure

MTMassive transfusion

NISSNew injury severity score

POCTPoint of care diagnostics

PTTPartial thromboplastin time

RISCRevised injury severity classification

SBPSystolic blood pressure

SIShock Index

TASH scoreTrauma associated severe haemorrhage score

TBITraumatic brain injury

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Autor: Matthias Fröhlich - Arne Driessen - Andreas Böhmer - Ulrike Nienaber - Alhadi Igressa - Christian Probst - Bertil Bouillo


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