Predictive accuracy of adding shock index to the American College of Surgeons' minimum criteria for full trauma team activation

Taylor McCormick; Jason Haukoos; Emily Hopkins; Stacy Trent; Kathleen Adelgais; Barry Platnick; Mitchell Cohen

doi:10.1111/acem.14459

Predictive accuracy of adding shock index to the American College of Surgeons' minimum criteria for full trauma team activation

Acad Emerg Med. 2022 May;29(5):561-571. doi: 10.1111/acem.14459. Epub 2022 Feb 27.

Authors

Taylor McCormick^{1

2}, Jason Haukoos^{1

2

3}, Emily Hopkins^{1

2}, Stacy Trent^{1

2}, Kathleen Adelgais⁴, Barry Platnick^{5

6}, Mitchell Cohen^{5

6}

Affiliations

¹ Department of Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA.
² Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
³ Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA.
⁴ Section of Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado, USA.
⁵ Department of Surgery, Denver Health Medical Center, Denver, Colorado, USA.
⁶ Department of Surgery, University of Colorado School of Medicine, Denver, Colorado, USA.

PMID: 35138668
DOI: 10.1111/acem.14459

Abstract

Background: The American College of Surgeons requires trauma centers to use six minimum criteria (ACS-6) for full trauma team activation: hypotension, gunshot wound to the neck or torso, Glasgow Coma Scale (GCS) score < 9, respiratory compromise, transfers receiving blood transfusion, or physician discretion. Our goal was to evaluate the effect of adding varying shock index (SI) thresholds to the ACS-6 in an adult trauma population with the hypothesis that SI would significantly improve sensitivity at the expense of an acceptable decrease in specificity.

Methods: We performed a secondary analysis of EMS and trauma registry data from an urban Level I trauma center. Consecutive patients > 15 years of age were included from 1993 through 2006. SI at thresholds of ≥0.8, ≥0.85, ≥0.9, and ≥1 were evaluated. Primary outcome was emergency operative (within 1 h of arrival) or procedural (cricothyrotomy or thoracotomy) intervention (EOPI); secondary outcomes were Injury Severity Score (ISS) > 15, ISS > 24, a composite of EOPI or ISS > 15, and urgent operative intervention (within 4 h).

Results: A total of 20,872 patients were included, 27% with an ISS > 15 and 5% who underwent EOPI. Sensitivity and specificity of the ACS-6 alone for EOPI were 86% (95% confidence interval [CI] = 84% to 88%) and 81% (95% CI = 80% to 81%), respectively. Inclusion of SI thresholds of 0.8, 0.85, 0.9, and 1 resulted in sensitivities of 95% (95% CI = 93% to 96%), 93% (CI = 91% to 94%), 92% (95% CI = 90% to 93%), and 90% (95% CI = 88% to 92%), respectively, and specificities of 52% (95% CI = 51% to 52%), 59% (95% CI = 58% to 59%), 64% (95% CI = 64% to 65%), and 72% (95% CI = 71% to 73%), respectively. Similar trends were found for each secondary outcome.

Conclusion: The addition of SI to the ACS-6 for trauma team activation increased sensitivity for EOPI with a larger decrease in specificity across all thresholds. Inclusion of a SI threshold of ≥0.9 closely aligns with under- and overtriage benchmarks in this trauma registry cohort using a strict definition of trauma team activation need.

Keywords: hospital triage; shock index; trauma team activation; trauma triage; triage criteria.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adult
Humans
Injury Severity Score
Retrospective Studies
Shock*
Surgeons*
Trauma Centers
Triage / methods
Wounds and Injuries* / diagnosis
Wounds and Injuries* / surgery
Wounds, Gunshot*

Abstract

Publication types

MeSH terms

Grants and funding