Shock Index as a Predictor of Mortality and Hospital Admission in Prehospital Gastrointestinal Bleeding: A Retrospective Cohort Study

Abstract

Objective

To evaluate the Shock Index (SI) as a predictive tool for triage of gastrointestinal bleeding (GI) in the prehospital setting, assessing its correlation with mortality, admission rates, and hospital length of stay.

Methods

In this retrospective cohort study, we analyzed data from the ESO Data Collaborative encompassing EMS records from the year 2022, focusing on 1525 patients with a primary GI bleeding diagnosis. The primary measure was the SI, calculated at initial contact and highest recorded prior to ED arrival. Statistical analysis included t-tests, linear regression, and ROC curves, performed using SPSS v29.

Results

A significantly higher mean SI was observed in patients who died (mean SI 0.997) compared to survivors (mean SI 0.795), p < 0.001. Admission rates also correlated with higher SI values, p < 0.001. However, SI was not predictive of the hospital length of stay. ROC analysis for mortality prediction yielded an AUC of 0.656 for the initial SI and 0.739 for the highest SI. The standard SI cutoff of 0.9 predicted mortality with a sensitivity of 74.14% and specificity of 55.35% for the highest SI.

Conclusion

The SI is a valuable predictive tool for mortality among prehospital patients with GI bleeding. Its application may improve the triage process, potentially influencing transport decisions and initial hospital care. Despite its predictive capability for mortality, the SI should be supplemented with other clinical assessments to make comprehensive prehospital care decisions. Further research into SI as part of a comprehensive assessment which includes end-title CO2, mentation, and heaviness of bleeding.

Acknowledgments

The views and opinions expressed in this publication are strictly those of the author(s). They do not necessarily reflect the official policy or position of the Department of the Air Force, Department of Defense, or the United States Government. Similarly, the viewpoints presented in this paper are not affiliated with the University of Texas Health Science Center at San Antonio (UTHSCSA), the San Antonio Office of Medical Direction, or UT Health.

Disclosure statement

The authors declare no conflicts of interest in relation to this study. The views and opinions expressed in this publication are strictly those of the author(s). They do not necessarily reflect the official policy or position of the Department of the Air Force, Department of Defense, or the United States Government. Similarly, the viewpoints presented in this paper are not affiliated with the University of Texas Health Science Center at San Antonio (UTHSCSA), the San Antonio Office of Medical Direction, or UT Health.

Additional information

Funding

This study was not supported by any outside sources.