Reverse shock index multiplied by Glasgow coma scale as a predictor of massive transfusion in trauma

Am J Emerg Med. 2021 Aug;46:404-409. doi: 10.1016/j.ajem.2020.10.027. Epub 2020 Oct 20.


Background and purpose: Previous studies have identified that the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG) is a good predictor of mortality in trauma patients. However, it is unknown if rSIG has utility as a predictor for massive transfusion (MT) in trauma patients. The present study evaluated the ability of rSIG to predict MT in trauma patients.

Methods: This was a retrospective, observational study performed at a level 1 trauma center. Consecutive patients who presented to the trauma center emergency department between January 2016 and December 2018 were included. The predictive ability of rSIG for MT was assessed as our primary outcome measure. Our secondary outcome measures were the predictive ability of rSIG for coagulopathy, in-hospital mortality, and 24-h mortality. We compared the prognostic performance of rSIG with the shock index, age shock index, and quick Sequential Organ Failure Assessment.

Results: In total, 1627 patients were included and 117 (7.2%) patients received MT. rSIG showed the highest area under the receiver operating characteristic (AUROC) curve (0.842; 95% confidence interval [CI], 0.806--0.878) for predicting MT. rSIG also showed the highest AUROC for predicting coagulopathy (0.769; 95% CI, 0.728-0.809), in-hospital mortality (AUROC 0.812; 95% CI, 0.772-0.852), and 24-h mortality (AUROC 0.826; 95% CI, 0.789-0.864). The sensitivity of rSIG for MT was 0.79, and the specificity of rSIG for MT was 0.77. All tools had a high negative predictive value and low positive predictive value.

Conclusion: rSIG is a useful, rapid, and accurate predictor for MT, coagulopathy, in-hospital mortality, and 24- h mortality in trauma patients.

Keywords: Glascow coma scale; Massive transfusion; Massive transfusion protocol; Reverse shock index; Trauma; rSIG.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Blood Transfusion / statistics & numerical data*
  • Female
  • Glasgow Coma Scale*
  • Hospital Mortality
  • Humans
  • Injury Severity Score*
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Republic of Korea
  • Retrospective Studies
  • Shock* / mortality
  • Trauma Centers
  • Wounds and Injuries / mortality
  • Wounds and Injuries / therapy*