A. Rafieezadeh1, K. Prabhakaran1, J. Kirsch1, J. Klein1, I. Shnaydman1, M. Bronstein1, J. Con1, A. Policastro1, B. Zangbar1 1New York Medical College, Surgery, Valhalla, NY, USA
Introduction:
The shock index (SI) is a known predictor of unfavorable outcomes in trauma. The utilization of SI might vary across different age groups. This study seeks to examine and compare the SI values between geriatric patients and younger adults.
Methods:
We conducted a retrospective study of TQIP database from 2017 to 2019. All patients≥ 25 years with injury severity score≥16 were included. Age groups were defined as 25- 44 years, 45-64 years and ≥ 65 years. SI was calculated. The primary outcome was mortality. Secondary outcomes were need for blood transfusion, need for exploratory laparotomy, and hemodynamic instability. Multiple logistic regressions and ROC curve were performed.
Results:
A total of 244,943 patients with the mean age of 54.6± 18.5 years were studied. Patient distribution was 33% in all three age groups. The SI was highest in 25- 44 group (0.82 ± 0.33) and lowest in ≥ 65 group (0.62 ± 0.30) (P< 0.001). Hemodynamic instability (21% vs 7%) and need for blood transfusion (15% vs 6.6%) were more frequent in 25- 44 group and least frequent in ≥ 65 group (P< 0.001). In 25- 44 group, higher SI was associated with mortality (OR= 3.380), need for blood transfusion (OR= 9.891) and need for exploratory laparotomy (OR= 6.454) (P< 0.001 for all). In ≥65 group the higher SI was associated with mortality (OR= 5.378), need for blood transfusion (OR= 21.773) and need for exploratory laparotomy (OR= 16.845) (P< 0.001 for all). The area under curve of SI was significantly higher in ≥ 65 group compared to younger patients for need for exploratory laparotomy (0.812 vs. 0.730) and need for blood transfusion (0.773 vs. 0.740) (P<0.001 for both).
Conclusion:
These results highlight the significance of the SI as a valuable indicator in geriatric patients with severe trauma. The findings show that SI predicts outcomes in geriatrics more strongly than in younger counterparts. Patients with a higher SI were 1.6 times more likely to die, 2.2 times more likely to receive blood transfusion and 2.6 times more likely to undergo laparotomy if they are geriatric.
