Evaluation of the shock index in dogs presenting as emergencies

Abstract

Objectives: To (1) determine a reference interval for shock index (SI) [defined as heart rate (HR)/systolic blood pressure (SBP)], in a group of healthy dogs, and (2) compare SI in healthy dogs with dogs presenting to the emergency room (ER) deemed to be in or not in a state of shock.

Design: Prospective study.

Animals: Sixty-eight clinically normal dogs, 18 dogs that were presented to the ER deemed to be in shock and 19 dogs presenting to the ER not deemed to be in shock.

Setting: University teaching hospital.

Interventions: Peripheral or central venous blood sampling.

Measurements and main results: Heart rate and SBP were recorded on simulated presentation (healthy dogs), and emergency presentations for both dogs deemed to be in shock and dogs not deemed in shock. Dogs in shock had a median SI of 1.37 (0.87-3.13), which was significantly higher than both other groups; dogs not deemed in shock had median SI 0.73 (0.56-1.20), P < 0.0001 and healthy dogs had median SI 0.78 (0.37-1.30) P < 0.0001), respectively. Receiver operator characteristic curve analysis suggested a SI cut-off of 1.0, yielding an area under the receiver operator characteristic (AUROC) of 0.89 (Specificity (Sp) 89, Sensitivity (Sn) 90) when comparing dogs deemed in shock with healthy dogs, and 0.92 (Sp 95, Sn 89) when comparing dogs in shock with to dogs not deemed in shock.

Conclusions: The SI is an easy and noninvasive patient parameter that is higher in dogs that are deemed to be in shock than both healthy dogs and dogs presented as emergencies but not deemed to be in a state of shock. The measurement of SI may have some benefit in clinical assessment of emergency patients.

Keywords: blood pressure; canine; heart rate; hypoperfusion; resuscitation.