University of Oulu

Björkman, J, Raatiniemi, L, Setälä, P, Nurmi, J. Shock index as a predictor for short-term mortality in helicopter emergency medical services: A registry study. Acta Anaesthesiol Scand. 2021; 65: 816– 823. https://doi.org/10.1111/aas.13765

Shock index as a predictor for short-term mortality in helicopter emergency medical services : a registry study

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Author: Björkman, Johannes1,2; Raatiniemi, Lasse3; Setälä, Piritta4;
Organizations: 1FinnHEMS Research and Development Unit, Vantaa, Finland
2University of Helsinki, Helsinki, Finland
3Centre for Emergency Medical Services, Oulu University Hospital, Oulu, Finland
4Emergency Medical Services, Tampere University Hospital, Tampere, Finland
5Emergency Medicine and Services, Helsinki University Hospital and Emergency Medicine, University of Helsinki, Helsinki, Finland
Format: article
Version: accepted version
Access: embargoed
Persistent link: http://urn.fi/urn:nbn:fi-fe2021102151982
Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-12-19
Description:

Abstract

Background: The value of shock-index has been demonstrated in hospital triage, but few studies have evaluated its prehospital use. The aim of our study was to evaluate the association between shock-index in prehospital critical care and short-term mortality.

Methods: We analyzed data from the national helicopter emergency medical services database and the Population Register Centre. The shock-index was calculated from the patients’ first measured parameters. The primary outcome measure was 1- and 30-day mortality.

Results: A total of 22 433 patients were included. The 1-day mortality was 7.5% and 30-day mortality was 16%. The median shock-index was 0.68 (0.55/0.84) for survivors and 0.67 (0.49/0.93) for non-survivors (P = .316) at 30-days. Association between shock-index and mortality followed a U-shaped curve in trauma (shock-index > 0.5: odds ratio 2.5 [95% confidence interval 1.8–3.4], shock-index > 1.3: odds ratio 4.4 [2.7–7.2] at 30 days). Patients with neurological emergencies with a low shock-index had an increased risk of mortality (shock-index < 0.5: odds ratio 1.8 [1.5–2.3]) whereas patients treated after successful resuscitation from out-of-hospital cardiac arrest, a higher shock-index was associated with higher mortality (shock-index > 1.3: odds ratio 3.5 [2.3–5.4). The association was similar for all ages, but older patients had higher mortality in each shock-index category.

Conclusions: The shock-index is associated with short time mortality in most critical patient categories in the prehospital setting. However, the marked overlap of shock-index in survivors and non-survivors in all patient categories limits its predictive value.

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Series: Acta anaesthesiologica Scandinavica
ISSN: 0001-5172
ISSN-E: 1399-6576
ISSN-L: 0001-5172
Volume: 65
Issue: 6
Pages: 816 - 823
DOI: 10.1111/aas.13765
OADOI: https://oadoi.org/10.1111/aas.13765
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Subjects:
Funding: This study was funded by Helsinki University Hospital (state funding, VTR TYH2019243) and the Research and Development Unit of FinnHEMS.
Copyright information: © 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd. This is the peer reviewed version of the following article: Björkman, J, Raatiniemi, L, Setälä, P, Nurmi, J. Shock index as a predictor for short-term mortality in helicopter emergency medical services: A registry study. Acta Anaesthesiol Scand. 2021; 65: 816– 823, which has been published in final form at https://doi.org/10.1111/aas.13765. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.