Is the shock index a useful tool in trauma patients with alcohol ingestion?

¹Department of Emergency Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
²Department of Emergency Medicine, Biomedical Research Institute, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Yangsan, Pusan National University School of Medicine, Busan, Korea
³Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
⁴Department of Biomedical Engineering, Graduate School, Pusan National University, Busan, Korea
⁵Department of Health Care Management, Catholic University of Pusan, Busan, Korea

Correspondence

Il Jae Wang ,Tel: 051-240-8769, Fax: 051-240-7719, Email: jrmr9933@gmail.com,

Received: September 24, 2022; Revised: October 30, 2022 Accepted: October 30, 2022. Published online: October 31, 2023.

ABSTRACT

Objective:
Alcohol consumption is a frequent risk factor for trauma. The shock index is widely used to predict the prognosis of trauma, and alcohol can influence the shock index in several ways. This study investigated the usefulness of the shock index in trauma patients who had ingested alcohol.
Method:
This was a retrospective, observational, single-center study. We performed a logistic regression analysis to assess the association between alcohol consumption and massive transfusions. A receiver operating characteristic (ROC) curve was constructed to determine the predictive value of the shock index for patients who had ingested alcohol.
Results:
A total of 5,128 patients were included in the study. The alcohol-positive group had lower systolic blood pressure and higher heart rate; consequently, the shock index in this group was higher. There was no significant difference between the proportion of the alcohol-positive and alcohol-negative groups who underwent massive transfusions and suffered hospital mortality compared to the overall proportion of patients who underwent massive transfusion based on the shock index. In the logistic regression analysis, the alcohol-negative group showed higher odds ratios for massive transfusions compared to the alcohol-positive group. The area under the ROC curve for predicting massive transfusion was 0.831 for the alcohol-positive group and 0.825 for the alcohol-negative group. However, when a cutoff value of 1 was used, the false positive rate was significantly higher in the alcohol-positive group.
Conclusion:
The shock index is a useful tool for predicting outcomes in patients with trauma. However, in patients who have ingested alcohol, the shock index should be interpreted with caution.

Key words: Shock; Alcohols; Multiple trauma; Blood transfusion