Incorporation of the Shock Index (SI) into the Trauma-Induced Coagulopathy Clinical Score (TICCS): an interesting combination to be further investigated.
Martin TONGLET, CHR de la Citadelle
28 April 2015
We would like to thank Pasquier and colleagues for their interest in our research on prehospital identification of trauma patients in need for Damage Control Resuscitation (DCR) and for their interesting suggestion. Whatever score or test is being used, we definitively and strongly believe that an early identification is pivotal for this dramatic situation. In this purpose, the Shock Index (SI) has, indeed, proven to be an interesting tool (1). Using an easy-to-calculate cut-off of SI >1, prehospital SI calculation may facilitate the prehospital identification of normotensive patients at relatively high risk for Massive Transfusion (MT) and DCR. Mutschler and colleagues also demonstrated that SI calculation could help to identify patients in need for MT (2). In their application of the SI to the German Trauma Society Registry, four classes of shock were identified based on the SI. Class III (with SI>1.0) and class IV (with SI >1.4) patients had a significant higher need for blood products transfusion. The prehospital SI application in the Alfred Trauma Registry also appeared to be predictive of critical bleeding but with low sensitivity (3,4). The SI could, therefore, be included in more sensitive scoring-systems. But those should, in our opinion, remain easy-to-calculate and should still focus on the very early phase after trauma. SI inclusion into TICCS calculation in place of the Systolic Blood Pressure SBP value could be interesting as SI showed to be a more reliable component that SBP. We performed a new calculation of the TICCS using SI instead of BP and didn’t find any significant difference (sensitivity 98.5%, specificity 66.7%). But this should be further studied on a larger cohort of trauma patients. So, from our side, in further planned studies, we will evaluate the interest of replacing BP by SI in the calculation of TICCS as suggested by Pasquier and colleagues.
Abbreviations
DCR: Damage Control Resuscitation
SI: Shock Index
MT: Massive Transfusion
TICCS: Trauma-Induced Coagulopathy Clinical Score
SBP: Systolic Blood Pressure
References
(1) Vandromme MJ, Griffin RL, Kerby JD, McGwin Jr G, Rue 3rd LW, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma 2011;70:384-8
(2) Mutschler M, Nienaber U, Munzberg M, Wolfl C, Schoechl H, Paffrath T, Bouillon B, Maegele M and the TraumaRegister DGU. 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
(3) Mitra B, Fitzgerald M, Chan J. The utility of shock index>1 as an indication for pre-hospital oxygen carrier administration in major trauma. Injury 2014 Jan;45(1):61-5
(4) Olaussen A, Peterson EL, Mitra B, O’Reilly G, Jennings PA, Fitzgerald M. Massive transfusion prediction with inclusion of the pre-hospital Shock Index. Injury 2015 May;46(5):822-6
Competing interests
The authors declare that they have no competing interests.
Critical Care
Incorporation of the Shock Index (SI) into the Trauma-Induced Coagulopathy Clinical Score (TICCS): an interesting combination to be further investigated.
28 April 2015
We would like to thank Pasquier and colleagues for their interest in our research on prehospital identification of trauma patients in need for Damage Control Resuscitation (DCR) and for their interesting suggestion. Whatever score or test is being used, we definitively and strongly believe that an early identification is pivotal for this dramatic situation. In this purpose, the Shock Index (SI) has, indeed, proven to be an interesting tool (1). Using an easy-to-calculate cut-off of SI >1, prehospital SI calculation may facilitate the prehospital identification of normotensive patients at relatively high risk for Massive Transfusion (MT) and DCR. Mutschler and colleagues also demonstrated that SI calculation could help to identify patients in need for MT (2). In their application of the SI to the German Trauma Society Registry, four classes of shock were identified based on the SI. Class III (with SI>1.0) and class IV (with SI >1.4) patients had a significant higher need for blood products transfusion. The prehospital SI application in the Alfred Trauma Registry also appeared to be predictive of critical bleeding but with low sensitivity (3,4). The SI could, therefore, be included in more sensitive scoring-systems. But those should, in our opinion, remain easy-to-calculate and should still focus on the very early phase after trauma. SI inclusion into TICCS calculation in place of the Systolic Blood Pressure SBP value could be interesting as SI showed to be a more reliable component that SBP. We performed a new calculation of the TICCS using SI instead of BP and didn’t find any significant difference (sensitivity 98.5%, specificity 66.7%). But this should be further studied on a larger cohort of trauma patients. So, from our side, in further planned studies, we will evaluate the interest of replacing BP by SI in the calculation of TICCS as suggested by Pasquier and colleagues.
Abbreviations
DCR: Damage Control Resuscitation
SI: Shock Index
MT: Massive Transfusion
TICCS: Trauma-Induced Coagulopathy Clinical Score
SBP: Systolic Blood Pressure
References
(1) Vandromme MJ, Griffin RL, Kerby JD, McGwin Jr G, Rue 3rd LW, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma 2011;70:384-8
(2) Mutschler M, Nienaber U, Munzberg M, Wolfl C, Schoechl H, Paffrath T, Bouillon B, Maegele M and the TraumaRegister DGU. 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
(3) Mitra B, Fitzgerald M, Chan J. The utility of shock index>1 as an indication for pre-hospital oxygen carrier administration in major trauma. Injury 2014 Jan;45(1):61-5
(4) Olaussen A, Peterson EL, Mitra B, O’Reilly G, Jennings PA, Fitzgerald M. Massive transfusion prediction with inclusion of the pre-hospital Shock Index. Injury 2015 May;46(5):822-6
Competing interests
The authors declare that they have no competing interests.