Mortality prediction using the Shock Index and Modified Shock Index in the Emergency Department.
Karoline Maciel Lopes, Marcos Barragan da Silva, Juciane Aparecida Furlan Inchauspe and 5 others
PMID 42659495WHAT IT FOUND
In 365 emergency patients with shock, the Modified Shock Index predicted in-hospital death better than the Shock Index in septic, mixed and cardiogenic shock.
In hypovolemic shock, both performed similarly.
Key findings
01For septic shock, MSI had sensitivity 96.0% and specificity 86.3%, outperforming SI sensitivity 82.1% and specificity 54.9%.
02MSI also had higher sensitivity and specificity than SI in cardiogenic shock (90.0% and 77.8% versus 63.3% and 22.2%) and mixed shock (94.1% and 71.4% versus 76.5% and 57.1%).
03For hypovolemic shock, SI had sensitivity 88.9% and specificity 71.4%, compared with MSI sensitivity 81.5% and specificity 66.7%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The data were collected retrospectively from electronic records, and missing documentation could introduce information bias. The study was done in one emergency service in southern Brazil, and its mortality rate of 275 deaths among 365 patients may not apply in other settings. The best cutoff points were tested to identify the best performance, so they need prospective validation before routine use. Some shock types were small, including 39 cardiogenic and 24 mixed shock patients. SI and MSI were not part of the routine initial assessment, so the study did not test whether using them changes triage decisions or outcomes.
The easy way to misread this
Do not use MSI as a validated stand-alone triage score. The scores were not used in routine triage, the cutoffs were tested to identify best performance, and the reported AUC values were 0.700 or 0.735.