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Shock index predicts the need for massive transfusion protocol

OCTOBER 23, 2018
Clinical Congress Daily Highlights, Tuesday Second Edition

Predicting the need for a massive transfusion protocol (MTP) to provide rapid blood replacement in trauma patients with severe bleeding is important to appropriately coordinate and direct blood products, but remains challenging. On Tuesday afternoon, Ayman El-Menyar, MD, Hamad General Hospital, Doha, Qatar, presented a study investigating the predictive value of shock index (SI), as defined as heart rate divided by systolic blood pressure on admission, in patients with abdominal trauma.

The retrospective analysis included 1,134 patients with abdominal trauma requiring hospital admission, 49 percent of whom had SI greater than or equal to 0.8. In comparison with the lower SI group, patients with SI of 0.8 or above received more blood transfusions (59 percent vs. 23 percent) and MTP (25.7 percent vs. 3.1 percent). This group also had more retroperitoneal hematomas, splenic injury, exploratory laparotomy, and splenectomy, as well as longer hospital stays and higher mortality.

After adjusting for age and sex, injury severity score (ISS), Glasgow coma score (GCS), and abdomen abbreviated injury scale (AIS), SI was an independent predictor for exploratory laparotomy (aOR 2.23, p=0.001) and MTP (aOR 8.73, p=0.001). Dr. Menyar noted that “0.8 as a cutoff had negative predictive value of about 97 percent, which is very good.”

Together, the data suggest that SI of 0.80 or more on admission can predict the need for MTP and exploratory laparotomy in abdominal trauma and is associated with worse outcomes.

To view this study’s abstract, click here.

Additional Information:

The Scientific Forum, Shock Index: A Simple Predictor of Exploratory Laparotomy and Massive Blood Transfusion Protocol (MTP) in Patients with Abdominal Trauma, was held October 23, at the 2018 Clinical Congress of the American College of Surgeons in Boston, MA. Program, webcast and audio information is available at

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