Clinical benefits of shock index and modified shock index in pulmonary embolism for 30-day mortality prognosis
Clinical benefits of shock index and modified shock index in pulmonary embolism for 30-day mortality prognosis
Aim: It was evaluating the shock index and the modified shock index, which are strongly correlated with the severity of the shock.Determining the risk analysis in terms of early mortality of patients diagnosed with pulmonary thromboembolism (PE) in order tospecify treatment options and prognosis. Therefore, it is important to determine the severity of pulmonary embolism correctly.The available algorithms, such as the pulmonary embolism severity index, provide a prediction of the patients according to clinicalfindings. These algorithms score abnormal vital signs, medical findings, age, and comorbid diseases. However, vital signs innormal physiological limits cause errors in determining the severity of the disease. In this case, the problem is a lack of correlationbetween the severity of the disease and vital signs. Consequently, we need a more reliable parameter. In our study, we searched fora parameter that can be calculated easily in a dynamic manner, and which is not affected by normalized vital signs. We attemptedto find a parameter that could indicate the severity of the disease. Therefore, we evaluated the shock index and the modified shockindex, which are strongly correlated with the severity of the shock.Material and Methods: Patients diagnosed with pulmonary embolism were screened retrospectively between January 2012 andDecember 2017. A total of 99 patients whose pulmonary embolism was confirmed by angio-thoracic tomography were included inthe study. Heart rate, systolic and diastolic blood pressure were measured in these patients. Mean arterial pressure, shock index andthe modified shock index were also calculated. The values showing the severity of the disease were evaluated.Result When all the parameters were examined, the predictive power of deaths within 30 days was significant at differing degrees(p
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- 1. Janata K, Holzer M, Domanovits H, Met al. Mortality Of
Patients With Pulmonary Embolism. Wien Klin Wochenschr
2002;114:766-72
- 2. Pines JM, Mullins PM, Cooper JK, et al. National Trends
in emergency department use, care patterns, and quality
of care of older adults in the united states. J Am Geriatr
Soc 2013;61:12-7.
- 3. Platts-Mills TF, Travers D, Biese K, et al. Accuracy of
the Emergency Severity Index triage instrument for
identifying elder emergency department patients receiving
an immediate life-saving intervention. Acad Emerg
Med 2010;17:238-43.
- 4. Liu YC, Liu JH, Fang ZA, et al. World J modified shock
index and mortality rate of emergency patients. Emerg
Med 2012;3:114-7.
- 5. Singh A, Ali S, Agarwal A, et al. Correlation of shock index
and modified shock index with the outcome of adult trauma
patients: a prospective study of 9860 patients. N Am J Med
Sci 2014;6:450-2.
- 6. Konstantinides S, Goldhaber SZ. Pulmonary embolism: risk
assessment and management. Eur Heart J 2012;33:3014-22.
- 7. Bertoletti L, Le Gal G, Aujesky D, et al. Prognostic value
of the geneva prediction rule in patients with pulmonary
embolism. J Intern Med 2011;269:433-40.
- 8. Jiménez D, Aujesky D, Moores L, et al. Simplification of the
pulmonary embolism severity index for prognostication in
patients with acute symptomatic pulmonary embolism.
Arch Intern Med 2010;170:1383-9.
- 9. Righini M, Roy PM, Meyer G, Simplified pulmonary embolism
severity index (PESI): validation of a clinical prognostic
model for pulmonary embolism. J Thromb Haemost
2011;9:2115-7.
- 10. Jeffrey A. Kline, MD, Diane M. et al. Normalization of vital
signs does not reduce the probability of acute pulmonary
embolism in symptomatic emergency department patients.
Academıc Emerg Med 2012;19:11-7.
- 11. Kenneth T. Horlander, David M. et al. Pulmonary
embolism mortality in the United States, 1979-1998: an
analysis using multiple-cause mortality data. Arch Intern
Med 2003;163:1711-7.
- 12. Wells PS, Anderson DR, Rodger M, et al. Derivation of a
simple clinical model to categorize patients probability of
pulmonary embolism: increasing the models utility with the
simplired D-Dimer. Thromb Haemost 2000;83:416–20.
- 13. Kline JA, Corredor DM, Hogg MM, et al. Normalization of vital
signs does not reduce the probability of acute pulmonary
embolism in symptomatic emergency department
patients. Acad Emerg Med 2012;19:11-7.
- 14. Goldhaber SZ, Elliott CG. Acute pulmonary embolism:
part i: epidemiology, pathophysiology, and diagnosis.
Circulation. 2003;108:2726-9.
- 15. Kilic T, Ermis H, Gülbas G, et al. Prognostic Role of the
simplified pulmonary embolism severity index and
shock index in pulmonary embolism. Pol Arch Med
Wewn 2014;124:678-87.
- 16. Liu YC, Liu JH, Fang ZAet al. Modified shock index and
mortality rate of emergency patients. World J Emerg Med
2012;3:114-7.
- 17. Mcnab A, Burns B, Bhullar I, et al. An analysis of shock
index as a correlate for outcomes in trauma by age group.
Surgery 2013;154:384-7.
- 18. Smith JB, Pittet J-F, Pierce A. Hypotensive resuscitation. Curr
Anesthesiol Rep 2014;4:209-215.
- 19. Green RS, Butler MB, Erdogan M. Increased mortality in
trauma patients who develop post intubation hypotension.
J Trauma Acute Care Surg 2017;83:569-74.
- 20. Day DL, Anzelon KM, Conde FA. Association of prehospital
shock index and trauma bay uncrossmatched red blood
cell transfusion with multiple transfusion. J Trauma
Nurs 2016;23:89-95.
- 21. Birkhahn RH, Gaeta TJ, Terry D, et al. Shock index in
diagnosing early acute hypovolemia. Am J Emerg Med
2005;23:323-6.
- 22. Petrosoniak A, Hicks C. Resuscitation resequenced: a
rational approach to patients with trauma in shock. Emerg
Med Clin North Am 2018;36:41-60.
- 23. Strutt J, Flood A, Kharbanda AB. Shock index as a predictor
of morbidity and mortality in pediatric trauma patients.
Pediatr Emerg Care 2019;35:132–7.
- 24. Harada M, Takahashi T, Haga Y, et al. Comparative study
on quick sequential organ failure assessment, systemic
inflammatory response syndrome and the shock index in
prehospital emergency patients: single-site retrospective
study. Acute Med Surg 2019;6:131–7.
- 25. Davis JS, Johns JA, Olvera DJ, et al. Vital sign patterns
before shock related cardiopulmonary arrest. Resuscitation
2019;139:337-42.