Datasets entered into the TraumaRegister DGU® between 2002 and 2011 were retrieved for analysis. The inclusion criteria for the present study were age ≥16 years, primary admission, and complete datasets for SBP, HR and Glasgow Coma Scale as well as for BD upon ED admission. The SI was calculated for each individual patient by the ratio of HR to SBP.
Based upon previous observations by Zarzaur and colleagues [15 (link)], four groups of worsening SI were analyzed. Group I was defined a priori by SI <0.6 (no shock), group II by SI ≥0.6 to <1.0 (mild shock), group III by SI ≥1.0 to <1.4 (moderate shock) and group IV by SI ≥1.4 (severe shock). Analyses of vital signs, demographics and injury patterns as well as the therapeutic management such as transfusion rates, administration of fluids and the use of vasopressors were assessed for each SI group. Massive transfusion (MT) was defined by the administration of ≥10 blood products (including packed red blood cells, fresh frozen plasma and thrombocyte concentrates) until ICU admission. Coagulopathy was defined by a Quick’s value ≤70%, which is equivalent to International Normalized Ratio ≥1.3 [25 (link),26 (link)]. In accordance with the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, sepsis was defined by the presence of a systemic inflammatory response syndrome as a result of a confirmed infectious process [27 (link)].
For the comparison of the novel SI-based classification, the four groups of worsening SI were compared with our recently introduced BD-based classification of hypovolemic shock [7 (link)]. Patients were therefore classified according to their SI at ED admission and their BD at ED admission. For each classificatory approach, transfusion requirements were compared within the four groups.
Based upon previous observations by Zarzaur and colleagues [15 (link)], four groups of worsening SI were analyzed. Group I was defined a priori by SI <0.6 (no shock), group II by SI ≥0.6 to <1.0 (mild shock), group III by SI ≥1.0 to <1.4 (moderate shock) and group IV by SI ≥1.4 (severe shock). Analyses of vital signs, demographics and injury patterns as well as the therapeutic management such as transfusion rates, administration of fluids and the use of vasopressors were assessed for each SI group. Massive transfusion (MT) was defined by the administration of ≥10 blood products (including packed red blood cells, fresh frozen plasma and thrombocyte concentrates) until ICU admission. Coagulopathy was defined by a Quick’s value ≤70%, which is equivalent to International Normalized Ratio ≥1.3 [25 (link),26 (link)]. In accordance with the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference, sepsis was defined by the presence of a systemic inflammatory response syndrome as a result of a confirmed infectious process [27 (link)].
For the comparison of the novel SI-based classification, the four groups of worsening SI were compared with our recently introduced BD-based classification of hypovolemic shock [7 (link)]. Patients were therefore classified according to their SI at ED admission and their BD at ED admission. For each classificatory approach, transfusion requirements were compared within the four groups.
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