title: Is the shock index based classification of hypovolemic shock applicable in multiple injured patients with severe traumatic brain injury?-an analysis of the TraumaRegister DGU®.
abstract: BACKGROUND
  A new classification of hypovolemic shock based on the shock index (SI) was proposed in 2013. This classification contains four classes of shock and shows good correlation with acidosis, blood product need and mortality. Since their applicability was questioned, the aim of this study was to verify the validity of the new classification in multiple injured patients with traumatic brain injury.
  
  
  METHODS
  Between 2002 and 2013, data from 40 888 patients from the TraumaRegister DGU®were analysed. Patients were classified according to their initial SI at hospital admission (Class I: SI < 0.6, class II: SI ≥0.6 to <1.0, class III SI ≥1.0 to <1.4, class IV: SI ≥1.4). Patients with an additional severe TBI (AIS ≥ 3) were compared to patients without severe TBI.
  
  
  RESULTS
  16,760 multiple injured patients with TBI (AIShead≥3) were compared to 24,128 patients without severe TBI. With worsening of SI class, mortality rate increased from 20 to 53% in TBI patients. Worsening SI classes were associated with decreased haemoglobin, platelet counts and Quick's values. The number of blood units transfused correlated with worsening of SI. Massive transfusion rates increased from 3% in class I to 46% in class IV. The accuracy for predicting transfusion requirements did not differ between TBI and Non TBI patients.
  
  
  CONCLUSIONS
  The use of the SI based classification enables a quick assessment of patients in hypovolemic shock based on universally available parameters. Although the pathophysiology in TBI and Non TBI patients and early treatment methods such as the use of vasopressors differ, both groups showed an identical probability of recieving blood products within the respective SI class.
  
  
  CONCLUSIONS
  Regardless of the presence of TBI, the classification of hypovolemic shock based on the SI enables a fast and reliable assessment of hypovolemic shock in the emergency department. Therefore, the presented study supports the SI as a feasible tool to assess patients at risk for blood product transfusions, even in the presence of severe TBI.
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de.|Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Ostmerheimerstr.200, D-51109, Cologne, Germany. froehlichm@kliniken-koeln.de.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany. froehlichm@kliniken-koeln.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Fröhlich
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Driessen
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, Cologne-Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Böhmer
authors.affiliation: AUC-Academy for Trauma Surgery, Straße des 17. Juni 106-108, D-10623, Berlin, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nienaber
authors.affiliation: Department of Neurosurgery, Cologne-Merheim Medical Centre, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Alhadi
authors.initials: A
authors.lastname: Igressa
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Probst
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Maegele
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Ostmerheimer Str. 200, D-51109, Cologne, Germany.|Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Berlin, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Mutschler
mesh_terms: D000070642:Brain Injuries, Traumatic; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006801:Humans; D020896:Hypovolemia / Q000145:classification*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma; D012042:Registries; D012769:Shock / Q000145:classification*; D015599:Trauma Severity Indices
keywords: Haemorrhagic shock; Multiple trauma; Shock index; Traumatic brain injury