Shock Index

id

1316

full_title

Shock Index

short_title

Shock Index

med_description

May be a more sensitive indicator of occult shock, especially in trauma or acute hemorrhage.

description

The Shock Index indicates level of occult shock, especially in trauma or acute hemorrhage, based on heart rate and systolic blood pressure.

keywords

shock index, shock icu index, shock icu calc, shock icu score, shock icu measure, shock calc icu, shock s/p hemorrhage, shock s/p trauma, occult shock calc, occult shock score, occult shock trauma, occult shock hemorrhage, occult shock calc, shock level calc, shock heart rate, shock blood pressure, shock index HR, shock index BP, shock HR/SBP, HR/SBP, HR/SBP calc, HR/SBP index

complaint

[ "Bleeding", "Injury/Trauma" ]

formula

Shock Index = HR/SBP

evidence

The shock index (SI, calculated as heart rate divided by systolic blood pressure) was first proposed in the literature as a measure of shock severity by Allgöwer and Burri in 1967. More recently, the shock index has been further studied with modern protocols.

In large retrospective study by Mutschler et al (2013), 21,853 patients were identified in a trauma registry, and SI was calculated based on emergency department arrival vital signs. The degree of shock was found to correlate with increasing SI value. The need for blood products, fluids and vasopressors was also found to increase with higher SI values.

A retrospective study by Cannon et al (2009), performed at a single level I trauma center, identified 2,445 patients admitted over a five year period. Patients with SI >0.9 were found to have a significantly higher mortality (15.9%) when compared with patients with normal SI (6.3%)

In a retrospective registry study by Vandromme et al (2011), the authors identified 8,111 blunt trauma patients admitted at a single level I trauma center over an eight-year period. The shock index was calculated from recorded prehospital vital signs, and patients with SI >0.9 were found to have a 1.6-fold higher risk for massive transfusion.

In a retrospective study of 542 patients who underwent emergency intubation, Heffner et al (2013) identified a pre-intubation SI ≥0.9 to be independently associated with peri-intubation cardiac arrest.

A retrospective study of 2,524 patients that were screened for severe sepsis at a single center found that SI ≥0.7 performed as well as SIRS in NPV and was the most sensitive screening test for hyperlactatemia and 28-day mortality (Berger 2013).

Of note, in the ProCESS trial (2014), a large multicenter prospective randomized control study that enrolled 1,341 patients, the investigators compared different protocols of resuscitation of septic patients, and one of these protocols included SI ≥0.8 as a fluid resuscitation goal. There was no significant difference in mortality between the three intervention groups.

measurements

[ { "name": "Systolic BP", "unit": "sbp", "error_min": "30", "error_max": "300", "warn_min": "40", "warn_max": "250", "conversion": "1", "normal_max_si": "120", "normal_max_us": "120", "normal_min_si": "100", "normal_min_us": "100", "units_si": "mm Hg", "units_us": "mm Hg" }, { "name": "Heart Rate/Pulse", "unit": "hr", "error_min": "10", "error_max": "300", "warn_min": "20", "warn_max": "200", "conversion": "1", "normal_max_si": "100", "normal_max_us": "100", "normal_min_si": "60", "normal_min_us": "60", "units_si": "beats/min", "units_us": "beats/min" } ]

information

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.thieme-connect.com/DOI/DOI?10.1055/s-0028-1106070", "text": "Allgöwer M, Burri C. The “shock-index”. Dtsch med Wochenschr 1967; 92(43): 1947-1950. DOI: 10.1055/s-0028-1106070" } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23911630", "text": "Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation. 2013;84(11):1500–1504." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628475/", "text": "Berger T, Green J, Horeczko T, et al. Shock Index and Early Recognition of Sepsis in the Emergency Department: Pilot Study. WestJEM. 2013;14(2):168–174." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/24635773 ", "text": "ProCESS Investigators, Yealy DM, Kellum JA, et al. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014;370(18):1683–1693." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/25638631", "text": "Acker SN, Ross JT, Partrick DA, Tong S, Bensard DD. Pediatric specific shock index accurately identifies severely injured children. J Pediatr Surg. 2015;50(2):331-4." }, { "href": "https://www.injuryjournal.com/article/S0020-1383(17)30625-3/pdf", "text": "Schroll R, Swift D, Tatum D, et al. Accuracy of shock index versus ABC score to predict need for massive transfusion in trauma patients. Injury. 2018;49(1):15-19." }, { "href": "https://emj.bmj.com/content/36/5/293", "text": "Al Jalbout N, Balhara KS, Hamade B, Hsieh YH, Kelen GD, Bayram JD. Shock index as a predictor of hospital admission and inpatient mortality in a US national database of emergency departments. Emerg Med J. 2019;36(5):293-297." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/20009697", "text": "Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the Shock Index in Predicting Mortality in Traumatically Injured Patients. J Trauma. 2009;67(6):1426–1430." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/21307738", "text": "Vandromme MJ, Griffin RL, Kerby JD, McGwin G Jr., Rue LW III, Weinberg JA. Identifying Risk for Massive Transfusion in the Relatively Normotensive Patient: Utility of the Prehospital Shock Index. J Trauma. 2011;70(2):384–390." }, { "href": "https://ccforum.com/content/17/4/R172#B8", "text": "Mutschler M, Nienaber U, et al. The Shock Index revisited – a fast guide to transfusion requirement? A retrospective analysis on 21,853 patients derived from the TraumaRegister DGU®. Critical Care 2013, 17:R172 doi:10.1186/cc12851" } ], "Validations": [] }

pearls

• There are currently no large scale prospective studies validating the use of the Shock Index to guide resuscitative intervention.

• Shown to correlate with higher risk of mortality (likelihood ratio 5.67) and hospitalization (LR 6.64) at a cutoff of >1.3 (Al Jalbout 2019).

• A pediatric age-adjusted Shock Index (SIPA) better differentiates severely injured children (up to 16 years of age) (Acker 2015).

usecase

Consider in the following scenarios:

• Patients presenting with hemorrhage and trauma, to identify patients at increased risk for transfusion.

• Patients requiring endotracheal intubation, to help identify groups of patients at risk of post-intubation hypotension.

• Patients with suspected sepsis (found to be as sensitive as the SIRS criteria to identify patients at risk for sepsis, Berger 2013); however, note that a large RCT showed that use of the Shock Index to guide fluid resuscitation in sepsis did not demonstrate a mortality improvement (ProCESS Investigators 2014).

reasons

Blood pressure and heart rate, when used individually, fail to accurately predict the severity of hypovolemia and shock in major trauma. Massive transfusion of blood products can be associated with significant risk if initiated on the wrong patient. Identifying patients at risk for massive transfusion can be difficult, and objective measures like the Shock Index can help. Shown to be more sensitive than the ABC Score for Massive Transfusion (Schroll 2018).

next_advice

next_actions

Accuracy of Shock Index in identifying trauma patients in need of massive blood transfusion has not yet been prospectively investigated.

next_management

diseases

[ "Anemia", "Bleeding/Hemorrhage", "Trauma" ]

instructions

published

2022-04-21T20:28:58.111Z

purpose

[ "Diagnosis" ]

search_terms

[ "trauma", "hemorrhage", "occult" ]

seo

{ "keywords_en": "shock index, shock icu index, shock icu calc, shock icu score, shock icu measure, shock calc icu, shock s/p hemorrhage, shock s/p trauma, occult shock calc, occult shock score, occult shock trauma, occult shock hemorrhage, occult shock calc, shock level calc, shock heart rate, shock blood pressure, shock index HR, shock index BP, shock HR/SBP, HR/SBP, HR/SBP calc, HR/SBP index", "meta_description_en": "The Shock Index indicates level of occult shock, especially in trauma or acute hemorrhage, based on heart rate and systolic blood pressure." }

specialty

[ "Critical Care", "Emergency Medicine", "Hospitalist Medicine", "Internal Medicine", "Surgery (General)", "Surgery (Trauma)" ]

departments

[ "Cardiac" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 10058, "short_title_en": "Shock Index, Pediatric Age-Adjusted (SIPA)", "slug": "shock-index-pediatric-age-adjusted-sipa" }, { "calcId": 1236, "short_title_en": "TASH Score", "slug": "tash-score-trauma-associated-severe-hemorrhage" }, { "calcId": 3952, "short_title_en": "CHIP Prediction Rule", "slug": "chip-ct-head-injury-patients-prediction-rule" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology" ]

cleaned_use

[ "Consider in the following scenarios:", "Patients presenting with hemorrhage and trauma, to identify patients at increased risk for transfusion.", "Patients requiring endotracheal intubation, to help identify groups of patients at risk of post-intubation hypotension.", "Patients with suspected sepsis (found to be as sensitive as the SIRS criteria to identify patients at risk for sepsis,Berger 2013); however, note that a large RCT showed that use of the Shock Index to guide fluid resuscitation in sepsis did not demonstrate a mortality improvement (ProCESS Investigators 2014)." ]

pub

true