J Korean Soc Emerg Med.  2024 Jun;35(3):223-230.

Using the pre-hospital shock index multiplied by the AVPU scale as a predictor of massive transfusion and coagulopathy in patients with trauma

• Choi YH
• Yeom SR
• Park SW
• Yang WT
• Wang IJ
• Tae WU
• Cho SJ
• Lee DS
• Min MK
• Huh U
• Song C
• Kim Y
• Cho Y

Abstract

Objective
This study evaluated the accuracy of the pre-hospital shock index multiplied by the AVPU scale (PSIAVPU) as a predictor of massive transfusion (MT) and traumatic coagulopathy.
Methods
This research was a retrospective single-center study that included patients consecutively presenting to a trauma center between 2017 and 2020. The predictive value of the PSIAVPU for MT, in-hospital mortality, and traumatic coagulopathy was measured using the area under the curve (AUC) of the receiver operating characteristic curve. The AUC of the PSIAVPU was compared with the Reverse Shock Index multiplied by the Glasgow Coma Scale (rSIG) measured at the trauma center presentation.
Results
One thousand seven hundred and ninety-two patients were included, of which 163 patients (9.09%) received MT and 195 patients (10.88%) died during their hospital stay. Traumatic coagulopathy was observed in 245 patients. The AUC values for the PSIAVPU in terms of predicting MT, hospital mortality, and traumatic coagulopathy were 0.755, 0.752, and 0.736, respectively.
Conclusion
In patients with trauma, the predictive power of the PSIAVPU was higher than that of the prehospital shock index and was comparable to that of the rSIG. The PSIAVPU is a useful indicator that can be used easily and quickly for trauma patients at the prehospital stage.

Keyword

Shock; Wounds and injuries; Blood transfusion; Emergency medical services