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Delta Shock Index and higher incidence of emergency surgery in older adults with blunt trauma

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Abstract

Purpose

Vital signs are important for predicting clinical outcomes in patients with trauma. However, their accuracy can be affected in older adults because hemodynamic changes are less obvious. This study aimed to examine the usefulness of changes in vital signs during transportation in predicting the need for hemostatic treatments in older patients with trauma.

Methods

This retrospective cohort study was conducted using data from the Japan Trauma Data Bank (2004–2019). Patients aged ≥ 65 years who were hemodynamically stable at the scene were included in this study. The incidence of emergency surgery within 12 h after hospital arrival was compared between patients with delta Shock Index (dSI) > 0.1 and those with dSI ≤ 0.1. Predicting ability was examined after adjusting for patient demographics, comorbidities, vital signs at the scene and on hospital arrival, Injury Severity Score, and abbreviated injury scale in each region.

Results

Among the 139,242 patients eligible for the study, 3,701 underwent urgent hemostatic surgery within 12 h. Patients with dSI > 0.1 showed a significantly higher incidence of emergency surgery than those with dSI ≤ 0.1 (871/16,549 [5.3%] vs. 2,830/84,250 [3.4%]; odds ratio (OR), 1.60 [1.48–1.73]; adjusted OR, 1.22 [1.08–1.38]; p = 0.001). The relationship between high dSI and a higher incidence of intervention was observed in patients with hypertension and those with decreased consciousness on arrival.

Conclusion

High dSI > 0.1 was significantly associated with a higher incidence of urgent hemostatic surgery in older patients.

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Data availability

The data used in this study are available from the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine, but restrictions apply to the availability of these data, which were used under license for the current study, so these data are not publicly available. The data are available from the authors upon reasonable request and with permission of the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine.

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Acknowledgements

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan

    Shoma Funabiki, Ryo Yamamoto, Koichiro Homma, Jo Yoshizawa, Siqi Jia, Yukako Takanashi, Reo Kahara & Junichi Sasaki

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  1. Shoma Funabiki
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  8. Junichi Sasaki
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Contributions

SF and RY designed the study. SF, JS, YT, and RK performed data collection. JS contributed to quality control. SF, RY, KH, and JY performed data analysis, data interpretation, writing, and critical revision. All authors critically revised the manuscript and approved the version to be published.

Corresponding author

Correspondence to Ryo Yamamoto.

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Ethics approval and consent to participate

This study was approved by the IRB of Keio University School of Medicine. All the procedures were conducted in accordance with the tenets of the Declaration of Helsinki. The requirement for informed consent was waived due to the retrospective nature of the study.

Competing interests

The authors have no competing interests to declare that are relevant to the content of this article.

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Funabiki, S., Yamamoto, R., Homma, K. et al. Delta Shock Index and higher incidence of emergency surgery in older adults with blunt trauma. Eur J Trauma Emerg Surg 50, 561–566 (2024). https://doi.org/10.1007/s00068-023-02438-y

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