Mawar Ayub, Mawar Ayub
(2009)
value of shock index in risk stratification of
illness severity among patients in emergency
department.
Masters thesis, Pusat Pengajian Sains Perubatan.
Abstract
Risk stratification of patient is very important, ~g at the time patient anive in
Emergency Department. Wide range of patient's presentation sometimes can make them
appear normal where their vital signs are nonnal but they actually deteriorate in time. We
should not miss this group of patient as the mortality and morbidity rate will increase. Objectives of this study is to develop range of Shock Index value to risk stratify patient
into 3 different groups which are low risk group, intennediate risk group and high risk
group.
This study was done in two centers which were Hospital Universiti Sains Malaysia
(HUSM) and Hospital Kuala Lumpur (HKL) from June 2008 till November 2008.
Patients older than 18 years old that came to Emergency Department of these two centers
and meet the inclusion and exclusion criteria were enrolled. The first vital signs of
patient were recorded by single reviewer and proceed with standard care of management.
Then the disposition of patient was recorded by the same reviewer. Significant variables
were initially identified. Then based on these values the range of Shock Index values
were developed using the receiver operating characteristic (ROC) curve. A minimum
value was identified, while the maximum value of 0.9 which has been extensively
validated was applied.
Total of 48 patients enrolled in this study. The significant parameters were systolic blood
pressure (p=<O.OOI), diastolic blood pressme (p=0.006), heart rate (p=<O.OOI) and
respiratory rate (p=0.004). Heart rate was the variable with most significant area under
the curve (AUR) in ROC curve which 8re 0.844. From there, minimum value of Shock
Index obtained was 0. 74 (sensitivity 80%, 1-specificity 74%).
Thus, range of Shock Index values are <0. 74 as low risk group, 0. 75 - 0.9 as
intennediate risk group and >0.9 as high risk group.
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