Summary
Validity of the Reverse Shock Index multiplied by the Glasgow Coma Scale score for determining mortality in patients with severe trauma in the prehospital environment
Affiliation of the authors
DOI
Quote
Benito Romeral CM, Sarmiento Torres JA, Corral Torres E, Jiménez Gallego RM, Pérez Alonso A. Validity of the Reverse Shock Index multiplied by the Glasgow Coma Scale score for determining mortality in patients with severe trauma in the prehospital environment. Rev Esp Urg Emerg. 2024;3:150–5
Summary
BACKGROUND. Although various scales are available to predict mortality and prognosis for patients with severe trauma, they are difficult to apply in prehospital settings. The Reverse Shock Index multiplied by the Glasgow Coma Scale score (rSIG) has been reported to predict mortality in severe trauma.
OBJECTIVES. The main objective was to study whether the rSIG was a better prehospital predictor of mortality in severe trauma than the Shock Index (SI), the Age SI, or the Revised Trauma Score (RTS). The secondary aims were to determine the predictive power of hemodynamic and analytic variables and to analyze the metabolic and hemodynamic status of patients with a low rSIG.
MATERIAL AND METHODS. Retrospective observational study of a cohort of patients over the age of 16 years who were attended by an out-of-hospital emergency service for severe trauma between June 2021 and December 2023. We calculated the areas under the receiver operating characteristic curves (AUCs) for the rSIG and the other indexes as predictors of 7-day mortality. We also
analyzed the AUCs for analytic parameters and vital constants.
RESULTS. The cases of 619 patients were studied. The mean patient age was 42.1 years, 79.8% were male, and overall 7-day mortality was 10.3%. Only the rSIG (AUC, 0.734; 95% CI, 0.807-0.660; P < .001) and the RTS (AUC, 0.734, 95% CI, 0.807-0.660; P < .001) predicted mortality. The rSIG cut point of 12.7 had a sensitivity of 70.3% and a specificity of 69.7% for 7-day mortality.
CONCLUSIONS. Even considering the limitations of this study, the rSIG seems to be a useful prehospital predictor of mortality in severe trauma attended out-of-hospital and may be comparable to other internationally validated scales such as the RTS. A value of less than 12.7 on the rSIG should possibly be considered a predictor of potentially high-risk.