Published online Mar 9, 2024. doi: 10.5492/wjccm.v13.i1.90617
Peer-review started: December 8, 2023
First decision: December 19, 2023
Revised: December 28, 2023
Accepted: January 22, 2024
Article in press: January 22, 2024
Published online: March 9, 2024
Processing time: 87 Days and 8.7 Hours
The increase in severe traumatic brain injury (sTBI) incidence is a worldwide phenomenon, resulting in a heavy disease burden in the public health systems, specifically in emerging countries. The shock index (SI) is a physiological parameter that indicates cardiovascular status and has been used as a tool to assess the presence and severity of shock, which is increased in sTBI. Considering the high mortality of sTBI, scrutinizing the predictive potential of SI and its variants is vital.
To describe the predictive potential of SI and its variants in sTBI.
This study included 71 patients (61 men and 10 women) divided into two groups: Survival (S; n = 49) and Non-survival (NS; n = 22). The responses of blood pressure and heart rate (HR) were collected at admission and 48 h after admission. The SI, reverse SI (rSI), rSI multiplied by the Glasgow Coma Score (rSIG), and Age multiplied SI (AgeSI) were calculated. Group comparisons included Shapiro-Wilk tests, and independent samples t-tests. For predictive analysis, logistic regression, receiver operator curves (ROC) curves, and area under the curve (AUC) measurements were performed.
No significant differences between groups were identified for SI, rSI, or rSIG. The AgeSI was significantly higher in NS patients at 48 h following admission (S: 26.32 ± 14.2, and NS: 37.27 ± 17.8; P = 0.016). Both the logistic regression and the AUC following ROC curve analysis showed that only AgeSI at 48 h was capable of predicting sTBI outcomes.
Although an altered balance between HR and blood pressure can provide insights into the adequacy of oxygen delivery to tissues and the overall cardiac function, only the AgeSI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.
Core Tip: Patients who suffer severe head trauma are also affected by altered balance between heart rate and blood pressure which influences oxygen delivery to tissues and the overall cardiac function. Although previous studies indicated that shock index (SI) and its variants could predict the outcomes following traumatic brain injury (TBI) the studies were conducted in patients with different severities of injury. Therefore, when evaluating patients who suffered a severe TBI (sTBI), the SI and its variants are not a viable outcome-predictive tool in sTBI, due to similar responses in both surviving and non-surviving patients. However, the Age multiplied SI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.