Modified shock index as a predictor of early outcomes among adult trauma patients admitted at Bugando medical centre, Mwanza, Tanzania.

Abstract

Modified shock index as a predictor of early outcomes among adult trauma patients admitted at Bugando medical centre, Mwanza, Tanzania.

Suleiman Rashid¹*, Vihar Kotecha¹, Ally Akrab²

*Corresponding author (Email: suleimanorashid@yahoo.com, WhatsApp: +255658928492)

Department of surgery Bugando Medical Centre

Department of Emergency Medicine Bugando Medical Centre

Catholic University of Health and Allied Science CUHAS-BUGANDO

ABSTRACT

Introduction: Modified shock index has been reported to be a useful in predicting early outcomes of trauma patients. This study aimed to determine the usefulness of modified shock index in predicting early outcomes among trauma patients admitted at Bugando Medical Centre.

Methods: This was a prospective cross sectional study of all adult trauma patients (aged ≥ 18 years) with KTS II of moderate to severe from January to May 2023. The study was conducted at EMD, intensive care unit and all surgical wards of BMC. The modified shock index was calculated on arrival by dividing heart rate by the mean arterial pressure and its association to within 24 hours ICU admission, blood transfusion, emergency surgical intervention, and mortality was determined. Collected data was analysed using STATA version 15.0. Predictors were run in multivariate regression model to ascertain statistical relationship.

Results: We enrolled 188 participants, majority were males 166(87.8%) and median age was 33.5 [IQR 25-41] years. Road traffic accident was the most common mechanism of injury accounting for 145(77.1%) participants. Head and neck was the most common body region affected followed by extremities in 123(65.4%) and 89(47.3%) respectively. Within 24 hours of admission, blood was transfused in 105(55.8%), emergency surgical intervention was 115(61.2%), ICU admissions was 44(23.4%) patients, and 18(9.6%) patients died. High MSI (> 0.9) was found to be predictor of blood transfusion (OR=3.44; 95% [1.24-9.81], p-value =0.021), ICU admission (OR=4.21, 95%CI [2.07-8.57], p-value <0.001] and mortality (OR = 2.82, 95%CI [2.36-9.92], p-value = 0.011) but not need for emergency surgical intervention (OR=1.66[0.88-3.13]; p-value = 0.115) within 24 hrs of admission.

Conclusion: High modified shock index was a predictor for blood transfusion, ICU admission and mortality among trauma patients. We recommended that MSI should be recorded in the patient chart upon initial assessment of trauma patients.

Key words: Modified shock index, predictor, trauma patient, early outcome, Bugando Medical Centre, Tanzania