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
Patients who suffer severe head trauma are also affected by altered balance between heart rate (HR) 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.
To the best of our knowledge, there are no studies that assess the role of SI and its variants as a predictor tool of mortality in severe TBI (sTBI) patients without multiple central injuries. The findings of this study can guide future clinical procedures to ensure a positive impact on the prognosis and quality of life of this population.
This study aims to describe the predictive potential of SI and its variants as an outcome-predictive tool in sTBI patients.
This was a prospective observational study conducted at the Pronto-Socorro Hospital, a trauma reference center at Porto Alegre, RS, Brazil, including 71 patients were included in this study. The study included retrospective data, covering the period from January 2019 to December 2022. The collected variables were: Glasgow Coma Scale (GCS) score, injury description, age, sex, days of fasting, body mass, estimated height, blood pressure, and HR parameters. Body mass index (BMI = body mass/Height2) was calculated to classify the patients according to the criteria of the World Health Organization. The SI, reverse SI (rSI), and rSI multiplied by the Glasgow Coma Score (rSIG) were calculated as the ratio of HR to systolic blood pressure (SBP) (SI = HR/SBP), ratio of SBP to HR (rSI = SBP/HR), the score of rSI × GCS, and age multiplied SI (AgeSI = Age × SI) respectively. 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 non-survival (NS) patients at 48 h following admission (Survival: 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. For AgeSI at 48 h, the AUROC curve for predicting mortality was 0.727.
Patients who suffer severe head trauma are also affected by altered balance between HR and blood pressure which influences oxygen delivery to tissues and the overall cardiac function. Although previous studies indicated that SI and its variants could predict the outcomes following TBI the studies were conducted in patients with different severities of injury. Therefore, when evaluating patients who suffered a 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 AgeSI was a viable outcome-predictive tool in sTBI, warranting future research in different cohorts.
Future studies should evaluate the AgeSI as an outcome-predictive tool in sTBI.