Shock index as a predictor for short-term mortality in helicopter emergency medical services : a registry study
Björkman, Johannes; Raatiniemi, Lasse; Setälä, Piritta; Nurmi, Jouni (2020-12-19)
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
© 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.
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https://urn.fi/URN:NBN:fi-fe2021102151982
Tiivistelmä
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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