title: Prediction of massive bleeding. Shock index and modified shock index.
abstract: OBJECTIVE
  To determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  Severe trauma patient's initial attention at the intensive care unit of a tertiary hospital.
  
  
  METHODS
  Patients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015.
  
  
  METHODS
  We studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV-), positive and negative likelihood ratio (LR+ and LR-), ROC curves (Receiver Operating Characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage.
  
  
  RESULTS
  287 patients were included, 76.31% (219) were male, mean age was 43,36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21-34). The overall frequency of massive bleeding was 8.71% (25). For Shock Index: AUROC was 0.89 (95% confidence intervals [CI] 0.84 to 0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2 to 97.58) and Sp was 79.69% (95% CI: 74.34 to 84.16). For the Modified Shock Index: AUROC was 0.90 (95% CI: 0.86 to 0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01 to 99.23) and Sp was 75.78% (95% CI: 70.18 to 80.62).
  
  
  CONCLUSIONS
  Shock Index and Modified Shock Index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma.
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: luchoter000@hotmail.com.
authors.forename: L J
authors.initials: LJ
authors.lastname: Terceros-Almanza
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: García-Fuentes
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Bermejo-Aznárez
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: I J
authors.initials: IJ
authors.lastname: Prieto-Del Portillo
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Mudarra-Reche
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Sáez-de la Fuente
authors.affiliation: Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Chico-Fernández
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001803:Blood Transfusion; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012771:Shock, Hemorrhagic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000706:statistics & numerical data
keywords: Escala de severidad del trauma; Escala de trauma revisado; Hemorragia masiva; Injury severity score; Massive bleeding; Massive transfussion; Modified shock index; Revised trauma score; Shock index; Transfusión masiva; Índice de shock; Índice de shock modificado