Association of Age Shock Index with Mortality among Trauma Patients in the Emergency Department

Association of Age Shock Index with Mortality

Authors

  • Areej Zehra Department of Accident and Emergency, Ziauddin University, Karachi, Pakistan
  • Inayat Ali Khan Department of Medicine Emergency, Ziauddin University, Karachi, Pakistan
  • Muhammad Khan Department of Pathology, Baqai Medical College, Baqai University, Karachi, Pakistan
  • Shahid Pervez Shaikh Department of Anatomy, Baqai Medical College, Baqai University, Karachi, Pakistan
  • Padma Rathore Department of Physiology, Jinnah Sindh Medical University, Karachi, Pakistan
  • Ghazal Irfan Department of Pathology, Baqai Medical College, Baqai University, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i1.2209

Keywords:

Age Shock Index (ASI), Mortality Rate, Emergency Department (ED), Trauma

Abstract

Trauma injuries cause significant global morbidity and mortality. While current scoring systems like ISS and TRISS are complex, the Age Shock Index (ASI) offers a simpler, potentially more effective method for estimating patient outcomes. Objective: To evaluate the association of Age Shock Index with 48-hour in-hospital mortality in a trauma population in an Emergency Department (ED). Methods: A comparative cross-sectional study was conducted over eight months in the Emergency Department of Ziauddin University, focusing on pre-selected trauma patients aged 18-65 years. Patients were divided into two groups: the exposed group and non-exposed group, with an Age Shock Index (ASI) ≥ 50, and < 50 respectively. Data analysis was carried out using descriptive statistics, the chi-square test, and independent t-tests with the Statistical Package for Social Sciences (SPSS) version 21.0. Results:  Patients with an Age Shock Index (ASI) ≥ 50 had significantly higher 48-hour in-hospital mortality (72%) compared to those with an ASI < 50 (12%) (p < 0.001). The exposed group also received more intravenous fluids, inotropic support, and blood products. No deaths occurred in the emergency room among the exposed group, but a trend towards higher overall mortality was observed (hazard ratio 48.584, 95% CI: 0.511 - 4622.17, p = 0.095). Conclusions: The Age Shock Index (ASI) ≥ 50 is associated with significantly higher 48-hour in-hospital mortality in trauma patients. The exposed group required more intensive interventions, indicating a higher severity of injury. ASI may serve as an effective predictor of patient outcomes in emergency settings.

References

Jung E, Ro YS, Ryu HH, Kajino K, Do Shin S. Pediatric Age-Adjusted Shock Index as A Predictor of Mortality by Sex Disparity in Pediatric Trauma: A Pan-Asian Trauma Outcome Study. Yonsei Medical Journal. 2023 Apr; 64(4): 278. doi: 10.3349/ymj.2022.0370. DOI: https://doi.org/10.3349/ymj.2022.0370

Newgard CD, Fischer PE, Gestring M, Michaels HN, Jurkovich GJ, Lerner EB et al. National Guideline for the Field Triage of Injured Patients: Recommendations of the National Expert Panel on Field Triage, 2021. Journal of Trauma and Acute Care Surgery. 2022 Aug; 93(2): e49-60. DOI: 10.1097/TA.0000000000003627. DOI: https://doi.org/10.1097/TA.0000000000003627

Vang M, Østberg M, Steinmetz J, Rasmussen LS. Shock Index as a Predictor for Mortality in Trauma Patients: A Systematic Review and Meta-Analysis. European Journal of Trauma and Emergency Surgery. 2022 Aug; 48(4): 2559-66. doi: 10.1007/s00068-022-01932-z. DOI: https://doi.org/10.1007/s00068-022-01932-z

Lin PC, Liu CY, Tzeng IS, Hsieh TH, Chang CY, Hou YT et al. Shock Index, Modified Shock Index, Age Shock Index Score, and Reverse Shock Index Multiplied by Glasgow Coma Scale Predicting Clinical Outcomes in Traumatic Brain Injury: Evidence From a 10-Year Analysis in a Single Center. Frontiers in Medicine. 2022 Nov; 9: 999481. doi: 10.1186/s40621-019-0217-8. DOI: https://doi.org/10.3389/fmed.2022.999481

Shi J, Shen J, Zhu M, Wheeler KK, Lu B, Kenney B et al. A New Weighted Injury Severity Scoring System: Better Predictive Power for Adult Trauma Mortality. Injury Epidemiology. 2019 Dec; 6: 1-0. doi: 10.3389/fmed.2022.999481. DOI: https://doi.org/10.1186/s40621-019-0217-8

Kim MJ, Park JY, Kim MK, Lee JG. Usefulness of Shock Index to Predict Outcomes of Trauma Patient: A Retrospective Cohort Study. Journal of Trauma and Injury. 2019 Mar; 32(1): 17-25. doi: 10.20408/jti.2018.034. DOI: https://doi.org/10.20408/jti.2018.034

Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA. Shock Index in the Emergency Department: Utility and Limitations. Open Access Emergency Medicine. 2019 Aug 14: 179-99. doi: 10.2147/OAEM.S178358. DOI: https://doi.org/10.2147/OAEM.S178358

Nazar M, Kumar H, Krishnegowda M, Unki P, Veerappa N, Srinivas BK. Validation of the Shock Index, Modified Shock Index, and Shock Index-Paediatric Age-Adjusted (SIPA) for Predicting Length of Stay and Outcome in Children Admitted at a Paediatric Intensive Care Unit. Egyptian Pediatric Association Gazette. 2022 Apr; 70(1): 12. doi:10.1186/s43054-022-00103-4. DOI: https://doi.org/10.1186/s43054-022-00103-4

Avci M and Doganay F. Prognostic Performance of Shock Index, Diastolic Shock Index, Age Shock Index, and Modified Shock Index in COVID-19 Pneumonia. Disaster Medicine and Public Health Preparedness. 2023 Jan; 17: e189. doi: 10.3389/fmed.2022.999481. DOI: https://doi.org/10.1017/dmp.2022.110

Montoya KF, Charry JD, Calle-Toro JS, Núñez LR, Poveda G. Shock Index as a Mortality Predictor in Patients with Acute Polytrauma. Journal Of Acute Disease. 2015 Aug; 4(3): 202-4. doi: 10.1016/j.joad.2015.04.006. DOI: https://doi.org/10.1016/j.joad.2015.04.006

Uluç K. Prognostic Value of Shock Index, Modified Shock Index, and Age Shock Index in Patients with Sepsis in the Intensive Care Unit. Kocaeli Üniversitesi Sağlık Bilimleri Dergisi. 2024 Sep; 10(3): 96-100. doi: 10.30934/kusbed.1518819. DOI: https://doi.org/10.30934/kusbed.1518819

Aleka P, Van Koningsbruggen C, Hendrikse C. The Value of Shock Index, Modified Shock Index and Age Shock Index to Predict Mortality and Hospitalisation in a District Level Emergency Centre. African Journal of Emergency Medicine. 2023 Dec; 13(4): 287-92. doi: 10.1016/j.afjem.2023.09.007. DOI: https://doi.org/10.1016/j.afjem.2023.09.007

Shibahashi K, Sugiyama K, Okura Y, Hoda H, Hamabe Y. Can the Shock Index be a Reliable Predictor of Early Mortality after Trauma in Older Patients? A Retrospective Cohort Study. Acute Medicine & Surgery. 2019 Oct; 6(4): 385-91. doi: 10.1002/ams2.427. DOI: https://doi.org/10.1002/ams2.427

Carsetti A, Antolini R, Casarotta E, Damiani E, Gasparri F, Marini B, Adrario E, Donati A. Shock Index as Predictor of Massive Transfusion and Mortality in Patients with Trauma: A Systematic Review and Meta-Analysis. Critical Care. 2023 Mar; 27(1): 85. doi: 10.1186/s13054-023-04386-w. DOI: https://doi.org/10.1186/s13054-023-04386-w

Demir A and Eren F. The Relationship Between Age Shock Index, and Severity of Stroke and In-Hospital Mortality in Patients with Acute Ischemic Stroke. Journal Of Stroke and Cerebrovascular Diseases. 2022 Aug; 31(8): 106569. doi: 10.1016/j.jstrokecerebrovasdis.2022.106569. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106569

Costa YC, Cáceres L, Mauro V, Fairman E, Fernández A, Soricetti J et al. Shock Index, Modified Shock Index, and Age-Adjusted Shock Index as Predictors of In-Hospital Death in Acute Heart Failure. Sub Analysis of the ARGEN IC. Current Problems in Cardiology. 2022 Oct 1; 47(10): 101309. doi: 10.1016/j.cpcardiol.2022.101309. DOI: https://doi.org/10.1016/j.cpcardiol.2022.101309

Rau CS, Wu SC, Kuo SC, Pao-Jen K, Shiun-Yuan H et al. Prediction of Massive Transfusion in Trauma Patients with Shock Index, Modified Shock Index, and Age Shock Index. International Journal of Environmental Research and Public Health. 2016 Jul; 13(7): 683. doi:10.3390/ijerph13070683. DOI: https://doi.org/10.3390/ijerph13070683

Yu T, Tian C, Song J, He D, Sun Z, Sun Z. Age Shock Index is Superior to Shock Index and Modified Shock Index for Predicting Long-Term Prognosis in Acute Myocardial Infarction. Shock. 2017 Nov; 48(5): 545-50. Doi: 10.1097/SHK.0000000000000892. DOI: https://doi.org/10.1097/SHK.0000000000000892

Colarusso L, Brahmbhatt DH, Scolari FL, Keon KA, Shin E, De Pellegrin Overgaard et al. Decoding Cardiogenic Shock: Assessing Shock Index and its Variants aas Prognostic Indicators for In‐Hospital Mortality. ESC Heart Failure. 2024. doi: 10.1002/ehf2.14853. DOI: https://doi.org/10.1002/ehf2.14853

Günlü S, Kayan F, Karahan MZ. The Predictive Effect of Shock Index on Mortality in Patients with Acute Heart Failure. Journal Of Xiangya Medicine. 2023 Nov 20; 8. doi: 10.21037/jxym-23-20. DOI: https://doi.org/10.21037/jxym-23-20

Kim SY, Hong KJ, Do Shin S, Ro YS, Ahn KO, Kim YJ et al. Validation of the Shock Index, Modified Shock Index, and Age Shock Index for Predicting Mortality of Geriatric Trauma Patients in Emergency Departments. Journal of Korean Medical Science. 2016 Dec; 31(12): 2026-32. DOI: https://doi.org/10.3346/jkms.2016.31.12.2026

Aleka P. The Value of Shock Index, Modified Shock Index and Age Shock Index to Predict Critical Outcomes in a District Level Emergency Centre.

Levkowitz E, Gibson R, Xu H, Zhang LF, Eskine K, Buck B et al. Optimizing Triage: Assessing Shock Index, Pediatric Age-Adjusted as an Adjunct to Improve Emergency Severity Index Mistriage. Pediatric Emergency Care. 2024 Dec: 10-97. doi: 10.1097/PEC.0000000000003171. DOI: https://doi.org/10.1097/PEC.0000000000003171

Iramain R, Ortiz J, Jara A, Bogado N, Morinigo R, Cardozo L et al. Fluid Resuscitation and Inotropic Support in Patients with Septic Shock Treated in Pediatric Emergency Department: An Open-Label Trial. Cureus. 2022 Oct; 14(10). doi: 10.7759/cureus.30029. DOI: https://doi.org/10.7759/cureus.30029

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Published

2025-01-31
CITATION
DOI: 10.54393/pjhs.v6i1.2209
Published: 2025-01-31

How to Cite

Zehra, A., Khan, I. A., Khan, M., Shaikh, S. P., Rathore, P., & Irfan, G. (2025). Association of Age Shock Index with Mortality among Trauma Patients in the Emergency Department: Association of Age Shock Index with Mortality. Pakistan Journal of Health Sciences, 6(1), 209–213. https://doi.org/10.54393/pjhs.v6i1.2209

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