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Shock index in the emergency department: utility and limitations

Authors Koch E, Lovett S, Nghiem T, Riggs RA, Rech MA

Received 25 May 2019

Accepted for publication 24 July 2019

Published 14 August 2019 Volume 2019:11 Pages 179—199


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Erica Koch,1 Shannon Lovett,2 Trac Nghiem,2 Robert A Riggs,2 Megan A Rech2,3

1Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA; 2Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL 60153, USA; 3Department of Pharmacy, Loyola University Medical Center, Maywood, IL 60153, USA

Abstract: Shock index (SI) is defined as the heart rate (HR) divided by systolic blood pressure (SBP). It has been studied in patients either at risk of or experiencing shock from a variety of causes: trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, and ruptured ectopic pregnancy. While HR and SBP have traditionally been used to characterize shock in these patients, they often appear normal in the compensatory phase of shock and can be confounded by factors such as medications (eg, antihypertensives, beta-agonists). SI >1.0 has been widely found to predict increased risk of mortality and other markers of morbidity, such as need for massive transfusion protocol activation and admission to intensive care units. Recent research has aimed to study the use of SI in patients immediately on arrival to the emergency department (ED). In this review, we summarize the literature pertaining to use of SI across a variety of settings in the management of ED patients, in order to provide context for use of this measure in the triage and management of critically ill patients.

Keywords: shock index, emergency, trauma, hemorrhage, myocardial infarction, pulmonary embolism, sepsis, obstetrics, ectopic pregnancy, pediatrics

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