Vital signs monitoring critically ill patients in traditional triage: room for improvement and innovation
,
Abstract
Objective: In traditional triage, there is often a challenge in accurately assessing the severity of a patient's condition, which can result in under-triage or over-triage. The purpose of this study is to compare traditional and innovative vital signs in predicting possible mortality in critically ill patients. Methods: This is a cross-sectional study conducted over a three-month period. Patients presenting emergency severity index (ESI) level 1 and 2 triage were divided into two groups: those with and without mortality. Subsequently, the role of traditional triage vital signs [blood pressure, heart rate, oxygen saturation (SpO2), mean arterial pressure (MAP), pulse pressure (PP)] was compared with that of innovative vital signs [shock index (SI), reverse shock index (RSI), modified shock index (MSI), age-shock index (ASI)] in predicting mortality in two groups. Results: A total of 360 patients were included in the study. A statistically significant association was observed between all innovative and traditional vital signs (with the exception of heart rate) and mortality. In logistic regression, the univariate model revealed a significant association between age, triage level, innovative and traditional vital signs with the occurrence of mortality. In the multivariate model, only MAP, PP, SI, RSI×SpO2, and ASI were found to have a significant association with mortality. Conclusion: The combination of innovative and traditional vital signs, including MAP, PP, SI, MSI, RSI×SpO2, and ASI in triage may be capable of predicting critically ill patients with a higher probability of mortality.
1. Chalari E, Intas G, Stergiannis P, Paraskevas V, Fildissis G. The importance of vital signs in the triage of injured patients. Critical care nursing quarterly. 2012;35(3):292-8.
2. Sax DR, Warton EM, Mark DG, Vinson DR, Kene MV, Ballard DW, et al. Evaluation of version 4 of the emergency severity index in us emergency departments for the rate of mistriage. JAMA Network Open. 2023;6(3):e233404.
3. Salhi RA, Greenwood-Ericksen M, Kocher KE. National trends in vital sign abnormalities at arrival to the emergency department. Western Journal of Emergency Medicine. 2023;24(3):401
4. Rashid K, Ullah M, Ahmed ST, Sajid MZ, Hayat MA, Nawaz B, et al. Accuracy of emergency room triage using emergency severity index (esi): independent predictor of under and over triage. Cureus. 2021;13(12).
5. Lupton JR, Davis-O'Reilly C, Jungbauer RM, Newgard CD, Fallat ME, Brown JB, et al. Under-triage and over-triage using the field triage guidelines for injured patients: a systematic review. Prehospital Emergency Care. 2023;27(1):38-45.
6. Lentz BA, Jenson A, Hinson JS, Levin S, Cabral S, George K, et al. Validity of ED: addressing heterogeneous definitions of over-triage and under-triage. AJEM. 2017;35(7):1023-5.
7. Schell CO, Castegren M, Lugazia E, Blixt J, Mulungu M, Konrad D, et al. Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country. BMC research notes. 2015;8:1-7.
8. Su YC, Chien CY, Chaou CH, Hsu KH, Gao SY, Ng CJ. Revising vital signs criteria for accurate triage of older adults in the emergency department. International Journal of General Medicine. 2022;15:6227.
9. Erol M, Ülengin F, Dinçer HA. A Novel triage system design. In 2022 international congress on human-computer interaction, optimization and robotic applications (HORA) 2022 (pp. 1-7). IEEE.
10. Smischney NJ, Seisa MO, Schroeder DR. Association of shock indices with peri-intubation hypotension and other outcomes: a sub-study of the KEEP PACE trial. Journal of Intensive Care Medicine. 2024:08850666241235591.
11. Colarusso L, Brahmbhatt DH, Scolari FL, Keon KA, Shin E, De Pellegrin Overgaard AI, et al. Decoding cardiogenic shock: assessing shock index and its variants as prognostic indicators for in‐hospital mortality. ESC Heart Failure. 2024.
12. Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A, Ak R. Shock index as a predictor of mortality among the Covid-19 patients. AJEM. 2021;40:106-9.
13. Vang M, Østberg M, Steinmetz J, Rasmussen LS. Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery. 2022;48(4):2559-66.
14. Gupta S, Alam A. Shock index is better than conventional vital signs for assessing higher level of care and mortality in severe sepsis or shock. AJEM. 2021;46:545-9.
15. Sahu N, Yee S, Das M, Trinh S, Amoruso R, Connolly M, et al. Shock index as a marker for mortality rates in those admitted to the medical intensive care unit from the emergency department. Cureus. 2020;12(4).
16. Joseph B, Haider A, Ibraheem K, Kulvatunyou N, Tang A, Azim A, et al. Revitalizing vital signs: the role of delta shock index. Shock. 2016;46(3S):50-4.
17. Chuang JF, Rau CS, Wu SC, Liu HT, Hsu SY, Hsieh HY, et al. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Scandinavian Journal of Trauma, esuscitation and Emergency Medicine. 2016;24:1-0.
18. Lai WH, Rau CS, Hsu SY, Wu SC, Kuo PJ, Hsieh HY, et al. Using the reverse shock index at the injury scene and in the emergency department to identify high-risk patients: a cross-sectional retrospective study. International Journal of Environmental Research and Public Health. 2016;13(4):357.
19. Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emergency Medicine. 2024;24(1):26.
20. Torabi M, Mahani GS, Mirzaee M. Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA). International Journal of Emergency Medicine. 2023;16(1):88.
21. Kurt E, Bahadirli S. The usefulness of shock index and modified shock index in predicting the outcome of COVID-19 patients. Disaster Medicine and Public Health Preparedness. 2022;16(4):1558-63.
22. Chiang CY, Lin CF, Liu PH, Chen FC, Chiu IM, Cheng FJ. Clinical validation of the shock index, modified shock index, delta shock index, and shock index-C for emergency department ST-segment elevation myocardial infarction. Journal of Clinical Medicine. 2022;11(19):5839.
23. Lee K, Jang JS, Kim J, Suh YJ. Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department. AJEM. 2020;38(5):911-5.
24. Arroyo Monino DF, Garcia Gonzalez N, Lorenzo Lopez B, Sayago Silva I, Hidalgo Urbano RJ, Garcia Rubira JC. Age shock index, a better predictor of prognosis for our patients? European Heart Journal: Acute Cardiovascular Care. 2022;11(Supplement_1):zuac041-090.
25. Hou C, Wang X, Li Y, Hei F. The relationship between short-term mean arterial pressure variability and mortality in critically ill patients. Frontiers in Cardiovascular Medicine. 2022;9:870711.
26. Erickson SL, Killien EY, Wainwright M, Mills B, Vavilala MS. Mean arterial pressure and discharge outcomes in severe pediatric traumatic brain injury. Neurocritical care. 2021;34:1017-25.
27. Prasad KD, Abhinov T, Himabindu KC, Rajesh K, Moorthy DK. Modified shock index as an indicator for prognosis among sepsis patients with and without comorbidities presenting to the emergency department. Cureus. 2021;13(12).
28. Dogru U, Yuksel M, Ay MO, Kaya H, Ozdemır A, Isler Y, et al. The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study. Sao Paulo Medical Journal. 2022;140:531-9.
29. Yi S, Ning L, Xiao H. Elevated mean arterial pressure is associated with a lower risk of mortality in acute kidney injury patients receiving continuous renal replacement therapy. Renal Failure. 2023;45(1):2238828.
30. Yangchen T, Koraishy FM, Xu C, Hou W, Rohatgi R. Initial mean arterial blood pressure (MABP) measurement is a risk factor for mortality in hypertensive COVID-19 positive hospitalized patients. PLoS One. 2023;18(3):e0283331.
31. Zhu CS, Cobb D, Jonas RB, Pokorny D, Rani M, Cotner-Pouncy T, et al. Shock index and pulse pressure as triggers for massive transfusion. Journal of Trauma and Acute Care Surgery. 2019;87(1S):S159-64.
32. Ferreira AR, Mendes S, Leite L, Monteiro S, Pego M. Pulse pressure can predict mortality in advanced heart failure. Revista Portuguesa de Cardiologia. 2016;35(4):225-8.
33. Lempiäinen PA, Ylitalo A, Huikuri H, Kesäniemi YA, Ukkola OH. Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up. The Journal of Clinical Hypertension. 2021;23(8):1547-55.
34. Zhao L, Song Y, Dong P, Li Z, Yang X, Wang S. Brachial pulse pressure and cardiovascular or all‐cause mortality in the general population: a meta‐analysis of prospective observational studies. The Journal of Clinical Hypertension. 2014;16(9):678-85.
35. Gavish B, Bursztyn M, Thijs L, Wei DM, Melgarejo JD, Zhang ZY, et al. Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations. Journal of hypertension. 2022;40(11):2245-55.
36. Vakhshoori M, Bondariyan N, Sabouhi S, Shakarami M, Emami SA, Nemati S, et al. Impact of shock index (SI), modified SI, and age-derivative indices on acute heart failure prognosis: a systematic review and meta-analysis. PloS one. 2024 ;19(12):e0314528.
37. Schafer K, Van Sickle C, Hinojosa-Laborde C, Convertino VA. Physiologic mechanisms underlying the failure of the “shock index” as a tool for accurate assessment of patient status during progressive simulated hemorrhage. Journal of Trauma and Acute Care Surgery. 2013;75(2):S197-202.
38. Alsagaff MY, Kurniawan RB, Purwati DD, Haq AU, Saputra PB, Milla C, et al. Shock index in the emergency department as a predictor for mortality in COVID-19 patients: a systematic review and meta-analysis. Heliyon. 2023.
39. Middleton DJ, Smith TO, Bedford R, Neilly M, Myint PK. Shock index predicts outcome in patients with suspected sepsis or community-acquired pneumonia: a systematic review. Journal of clinical medicine. 2019;8(8):1144.
40. Carsetti A, Antolini R, Casarotta E, Damiani E, Gasparri F, Marini B, et al. Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis. Critical Care. 2023;27(1):85.
41. Jung E, Ryu HH, Heo BG. The reverse shock index multiplied by Glasgow coma scale (rSIG) is predictive of mortality in trauma patients according to age. Brain injury. 2023;37(5):430-6.
42. Chen TH, Wu MY, Do Shin S, Jamaluddin SF, Hong KJ, Jen-Tang S, et al. Discriminant ability of the shock index, modified shock index, and reverse shock index multiplied by the Glasgow coma scale on mortality in adult trauma patients: a PATOS retrospective cohort study. International Journal of Surgery. 2023;109(5):1231-8.
43. Wu SC, Rau CS, Kuo SC, Chien PC, Hsieh HY, Hsieh CH. The reverse shock index multiplied by Glasgow coma scale score (rSIG) and prediction of mortality outcome in adult trauma patients: a cross-sectional analysis based on registered trauma data. International journal of environmental research and public health. 2018;15(11):2346.
44. Wan-Ting C, Chin-Hsien L, Cheng-Yu L, Cheng-Yu C, Chi-Chun L, Keng-Wei C, et al. Reverse shock index multiplied by Glasgow coma scale (rSIG) predicts mortality in severe trauma patients with head injury. Scientific reports. 2020;10(1):2095.
45. Lin PC, Liu CY, Tzeng IS, Hsieh TH, Chang CY, Hou YT, et al. Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow coma scale predicting clinical outcomes in traumatic brain injury: Evidence from a 10-year analysis in a single center. Frontiers in medicine. 2022;9:999481.
46. Matsuda W, Kimura A, Uemura T. The reverse shock index multiplied by the Glasgow coma scale score can predict the need for initial resuscitation in patients suspected of sepsis. Global Health & Medicine. 2023;5(4):223-8.
47. Hsieh CC, Liu CY, Tsai KC, Jaw FS, Chen J. The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients. AJEM. 2023;65:65-70.
48. Hamade B, Bayram JD, Hsieh YH, Khishfe B, Al Jalbout N. Modified shock index as a predictor of admission and in-hospital mortality in emergency departments, an analysis of a US national database. Archives of Academic Emergency Medicine. 2023;11(1).
49. Sadeh RE, Shashar S, Shaer E, Slutsky T, Sagy I, Novack V, et al. Modified shock index as a predictor for mortality and hospitalization among patients with dementia. The Journal of Emergency Medicine. 2022;62(5):590-9.
50. Schmitz T, Harmel E, Linseisen J, Kirchberger I, Heier M, Peters A, et al. Shock index and modified shock index are predictors of long-term mortality not only in STEMI but also in NSTEMI patients. Annals of Medicine. 2022;54(1):900-8.
51. Althunayyan SM, Alsofayan YM, Khan AA. Shock index and modified shock index as triage screening tools for sepsis. Journal of infection and public health. 2019;12(6):822-6.
52. Wang IJ, Bae BK, Park SW, Cho YM, Lee DS, Min MK, et al. Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients. AJEM. 2020;38(2):187-90.
53. Wang S, Zhang Y, Qi D, Wang X, Zhu Z, Yang W, Li M, Hu D, Gao C. Age shock index and age-modified shock index are valuable bedside prognostic tools for post discharge mortality in ST-elevation myocardial infarction patients. Annals of Medicine. 2024;56(1):2311854.
54. Lee KJ, Kim YK, Jeon K, Ko RE, Suh GY, Oh DK, Lim SY, Lee YJ, Lee SY, Park MH, Lim CM. Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction. Plos one. 2024 ;19(3):e0298617.
55. Demir A, Eren F. The relationship between age shock index, and severity of stroke and in-hospital mortality in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2022;31(8):106569.
56. Costa YC, Cáceres L, Mauro V, Fairman E, Fernández A, Soricetti J, et al. Shock index, modified shock index, and age-adjusted shock index as predictors of in-hospital death in acute heart failure. Sub analysis of the ARGEN IC. Current Problems in Cardiology. 2022;47(10):101309.
57. Bondariyan N, Vakhshoori M, Sadeghpour N, Shafie D. Prognostic value of shock index, modified shock index, and age-adjusted derivatives in prediction of in-hospital mortality in patients with acute decompensated heart failure: Persian registry of cardiovascular disease/heart failure study. Anatolian Journal of Cardiology. 2022;26(3):210.
58. Koca A, Polat O, Oğuz AB, Genc S, Günalp M, Değirmenci S, et al. Reliability and validity of a new computer-based triage decision support tool: ANKUTRIAGE. Disaster Medicine and Public Health Preparedness. 2023;17:e162.
2. Sax DR, Warton EM, Mark DG, Vinson DR, Kene MV, Ballard DW, et al. Evaluation of version 4 of the emergency severity index in us emergency departments for the rate of mistriage. JAMA Network Open. 2023;6(3):e233404.
3. Salhi RA, Greenwood-Ericksen M, Kocher KE. National trends in vital sign abnormalities at arrival to the emergency department. Western Journal of Emergency Medicine. 2023;24(3):401
4. Rashid K, Ullah M, Ahmed ST, Sajid MZ, Hayat MA, Nawaz B, et al. Accuracy of emergency room triage using emergency severity index (esi): independent predictor of under and over triage. Cureus. 2021;13(12).
5. Lupton JR, Davis-O'Reilly C, Jungbauer RM, Newgard CD, Fallat ME, Brown JB, et al. Under-triage and over-triage using the field triage guidelines for injured patients: a systematic review. Prehospital Emergency Care. 2023;27(1):38-45.
6. Lentz BA, Jenson A, Hinson JS, Levin S, Cabral S, George K, et al. Validity of ED: addressing heterogeneous definitions of over-triage and under-triage. AJEM. 2017;35(7):1023-5.
7. Schell CO, Castegren M, Lugazia E, Blixt J, Mulungu M, Konrad D, et al. Severely deranged vital signs as triggers for acute treatment modifications on an intensive care unit in a low-income country. BMC research notes. 2015;8:1-7.
8. Su YC, Chien CY, Chaou CH, Hsu KH, Gao SY, Ng CJ. Revising vital signs criteria for accurate triage of older adults in the emergency department. International Journal of General Medicine. 2022;15:6227.
9. Erol M, Ülengin F, Dinçer HA. A Novel triage system design. In 2022 international congress on human-computer interaction, optimization and robotic applications (HORA) 2022 (pp. 1-7). IEEE.
10. Smischney NJ, Seisa MO, Schroeder DR. Association of shock indices with peri-intubation hypotension and other outcomes: a sub-study of the KEEP PACE trial. Journal of Intensive Care Medicine. 2024:08850666241235591.
11. Colarusso L, Brahmbhatt DH, Scolari FL, Keon KA, Shin E, De Pellegrin Overgaard AI, et al. Decoding cardiogenic shock: assessing shock index and its variants as prognostic indicators for in‐hospital mortality. ESC Heart Failure. 2024.
12. Doğanay F, Elkonca F, Seyhan AU, Yılmaz E, Batırel A, Ak R. Shock index as a predictor of mortality among the Covid-19 patients. AJEM. 2021;40:106-9.
13. Vang M, Østberg M, Steinmetz J, Rasmussen LS. Shock index as a predictor for mortality in trauma patients: a systematic review and meta-analysis. European Journal of Trauma and Emergency Surgery. 2022;48(4):2559-66.
14. Gupta S, Alam A. Shock index is better than conventional vital signs for assessing higher level of care and mortality in severe sepsis or shock. AJEM. 2021;46:545-9.
15. Sahu N, Yee S, Das M, Trinh S, Amoruso R, Connolly M, et al. Shock index as a marker for mortality rates in those admitted to the medical intensive care unit from the emergency department. Cureus. 2020;12(4).
16. Joseph B, Haider A, Ibraheem K, Kulvatunyou N, Tang A, Azim A, et al. Revitalizing vital signs: the role of delta shock index. Shock. 2016;46(3S):50-4.
17. Chuang JF, Rau CS, Wu SC, Liu HT, Hsu SY, Hsieh HY, et al. Use of the reverse shock index for identifying high-risk patients in a five-level triage system. Scandinavian Journal of Trauma, esuscitation and Emergency Medicine. 2016;24:1-0.
18. Lai WH, Rau CS, Hsu SY, Wu SC, Kuo PJ, Hsieh HY, et al. Using the reverse shock index at the injury scene and in the emergency department to identify high-risk patients: a cross-sectional retrospective study. International Journal of Environmental Research and Public Health. 2016;13(4):357.
19. Wu MY, Hou YT, Chung JY, Yiang GT. Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19. BMC Emergency Medicine. 2024;24(1):26.
20. Torabi M, Mahani GS, Mirzaee M. Reverse shock index (RSI) as a predictor of post-intubation cardiac arrest (PICA). International Journal of Emergency Medicine. 2023;16(1):88.
21. Kurt E, Bahadirli S. The usefulness of shock index and modified shock index in predicting the outcome of COVID-19 patients. Disaster Medicine and Public Health Preparedness. 2022;16(4):1558-63.
22. Chiang CY, Lin CF, Liu PH, Chen FC, Chiu IM, Cheng FJ. Clinical validation of the shock index, modified shock index, delta shock index, and shock index-C for emergency department ST-segment elevation myocardial infarction. Journal of Clinical Medicine. 2022;11(19):5839.
23. Lee K, Jang JS, Kim J, Suh YJ. Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department. AJEM. 2020;38(5):911-5.
24. Arroyo Monino DF, Garcia Gonzalez N, Lorenzo Lopez B, Sayago Silva I, Hidalgo Urbano RJ, Garcia Rubira JC. Age shock index, a better predictor of prognosis for our patients? European Heart Journal: Acute Cardiovascular Care. 2022;11(Supplement_1):zuac041-090.
25. Hou C, Wang X, Li Y, Hei F. The relationship between short-term mean arterial pressure variability and mortality in critically ill patients. Frontiers in Cardiovascular Medicine. 2022;9:870711.
26. Erickson SL, Killien EY, Wainwright M, Mills B, Vavilala MS. Mean arterial pressure and discharge outcomes in severe pediatric traumatic brain injury. Neurocritical care. 2021;34:1017-25.
27. Prasad KD, Abhinov T, Himabindu KC, Rajesh K, Moorthy DK. Modified shock index as an indicator for prognosis among sepsis patients with and without comorbidities presenting to the emergency department. Cureus. 2021;13(12).
28. Dogru U, Yuksel M, Ay MO, Kaya H, Ozdemır A, Isler Y, et al. The effect of the shock index and scoring systems for predicting mortality among geriatric patients with upper gastrointestinal bleeding: a prospective cohort study. Sao Paulo Medical Journal. 2022;140:531-9.
29. Yi S, Ning L, Xiao H. Elevated mean arterial pressure is associated with a lower risk of mortality in acute kidney injury patients receiving continuous renal replacement therapy. Renal Failure. 2023;45(1):2238828.
30. Yangchen T, Koraishy FM, Xu C, Hou W, Rohatgi R. Initial mean arterial blood pressure (MABP) measurement is a risk factor for mortality in hypertensive COVID-19 positive hospitalized patients. PLoS One. 2023;18(3):e0283331.
31. Zhu CS, Cobb D, Jonas RB, Pokorny D, Rani M, Cotner-Pouncy T, et al. Shock index and pulse pressure as triggers for massive transfusion. Journal of Trauma and Acute Care Surgery. 2019;87(1S):S159-64.
32. Ferreira AR, Mendes S, Leite L, Monteiro S, Pego M. Pulse pressure can predict mortality in advanced heart failure. Revista Portuguesa de Cardiologia. 2016;35(4):225-8.
33. Lempiäinen PA, Ylitalo A, Huikuri H, Kesäniemi YA, Ukkola OH. Nighttime ambulatory pulse pressure predicts cardiovascular and all‐cause mortality among middle‐aged participants in the 21‐year follow‐up. The Journal of Clinical Hypertension. 2021;23(8):1547-55.
34. Zhao L, Song Y, Dong P, Li Z, Yang X, Wang S. Brachial pulse pressure and cardiovascular or all‐cause mortality in the general population: a meta‐analysis of prospective observational studies. The Journal of Clinical Hypertension. 2014;16(9):678-85.
35. Gavish B, Bursztyn M, Thijs L, Wei DM, Melgarejo JD, Zhang ZY, et al. Predictive power of 24-h ambulatory pulse pressure and its components for mortality and cardiovascular outcomes in 11 848 participants recruited from 13 populations. Journal of hypertension. 2022;40(11):2245-55.
36. Vakhshoori M, Bondariyan N, Sabouhi S, Shakarami M, Emami SA, Nemati S, et al. Impact of shock index (SI), modified SI, and age-derivative indices on acute heart failure prognosis: a systematic review and meta-analysis. PloS one. 2024 ;19(12):e0314528.
37. Schafer K, Van Sickle C, Hinojosa-Laborde C, Convertino VA. Physiologic mechanisms underlying the failure of the “shock index” as a tool for accurate assessment of patient status during progressive simulated hemorrhage. Journal of Trauma and Acute Care Surgery. 2013;75(2):S197-202.
38. Alsagaff MY, Kurniawan RB, Purwati DD, Haq AU, Saputra PB, Milla C, et al. Shock index in the emergency department as a predictor for mortality in COVID-19 patients: a systematic review and meta-analysis. Heliyon. 2023.
39. Middleton DJ, Smith TO, Bedford R, Neilly M, Myint PK. Shock index predicts outcome in patients with suspected sepsis or community-acquired pneumonia: a systematic review. Journal of clinical medicine. 2019;8(8):1144.
40. Carsetti A, Antolini R, Casarotta E, Damiani E, Gasparri F, Marini B, et al. Shock index as predictor of massive transfusion and mortality in patients with trauma: a systematic review and meta-analysis. Critical Care. 2023;27(1):85.
41. Jung E, Ryu HH, Heo BG. The reverse shock index multiplied by Glasgow coma scale (rSIG) is predictive of mortality in trauma patients according to age. Brain injury. 2023;37(5):430-6.
42. Chen TH, Wu MY, Do Shin S, Jamaluddin SF, Hong KJ, Jen-Tang S, et al. Discriminant ability of the shock index, modified shock index, and reverse shock index multiplied by the Glasgow coma scale on mortality in adult trauma patients: a PATOS retrospective cohort study. International Journal of Surgery. 2023;109(5):1231-8.
43. Wu SC, Rau CS, Kuo SC, Chien PC, Hsieh HY, Hsieh CH. The reverse shock index multiplied by Glasgow coma scale score (rSIG) and prediction of mortality outcome in adult trauma patients: a cross-sectional analysis based on registered trauma data. International journal of environmental research and public health. 2018;15(11):2346.
44. Wan-Ting C, Chin-Hsien L, Cheng-Yu L, Cheng-Yu C, Chi-Chun L, Keng-Wei C, et al. Reverse shock index multiplied by Glasgow coma scale (rSIG) predicts mortality in severe trauma patients with head injury. Scientific reports. 2020;10(1):2095.
45. Lin PC, Liu CY, Tzeng IS, Hsieh TH, Chang CY, Hou YT, et al. Shock index, modified shock index, age shock index score, and reverse shock index multiplied by Glasgow coma scale predicting clinical outcomes in traumatic brain injury: Evidence from a 10-year analysis in a single center. Frontiers in medicine. 2022;9:999481.
46. Matsuda W, Kimura A, Uemura T. The reverse shock index multiplied by the Glasgow coma scale score can predict the need for initial resuscitation in patients suspected of sepsis. Global Health & Medicine. 2023;5(4):223-8.
47. Hsieh CC, Liu CY, Tsai KC, Jaw FS, Chen J. The hypoxia-age-shock index at triage to predict the outcomes of Covid-19 patients. AJEM. 2023;65:65-70.
48. Hamade B, Bayram JD, Hsieh YH, Khishfe B, Al Jalbout N. Modified shock index as a predictor of admission and in-hospital mortality in emergency departments, an analysis of a US national database. Archives of Academic Emergency Medicine. 2023;11(1).
49. Sadeh RE, Shashar S, Shaer E, Slutsky T, Sagy I, Novack V, et al. Modified shock index as a predictor for mortality and hospitalization among patients with dementia. The Journal of Emergency Medicine. 2022;62(5):590-9.
50. Schmitz T, Harmel E, Linseisen J, Kirchberger I, Heier M, Peters A, et al. Shock index and modified shock index are predictors of long-term mortality not only in STEMI but also in NSTEMI patients. Annals of Medicine. 2022;54(1):900-8.
51. Althunayyan SM, Alsofayan YM, Khan AA. Shock index and modified shock index as triage screening tools for sepsis. Journal of infection and public health. 2019;12(6):822-6.
52. Wang IJ, Bae BK, Park SW, Cho YM, Lee DS, Min MK, et al. Pre-hospital modified shock index for prediction of massive transfusion and mortality in trauma patients. AJEM. 2020;38(2):187-90.
53. Wang S, Zhang Y, Qi D, Wang X, Zhu Z, Yang W, Li M, Hu D, Gao C. Age shock index and age-modified shock index are valuable bedside prognostic tools for post discharge mortality in ST-elevation myocardial infarction patients. Annals of Medicine. 2024;56(1):2311854.
54. Lee KJ, Kim YK, Jeon K, Ko RE, Suh GY, Oh DK, Lim SY, Lee YJ, Lee SY, Park MH, Lim CM. Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction. Plos one. 2024 ;19(3):e0298617.
55. Demir A, Eren F. The relationship between age shock index, and severity of stroke and in-hospital mortality in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2022;31(8):106569.
56. Costa YC, Cáceres L, Mauro V, Fairman E, Fernández A, Soricetti J, et al. Shock index, modified shock index, and age-adjusted shock index as predictors of in-hospital death in acute heart failure. Sub analysis of the ARGEN IC. Current Problems in Cardiology. 2022;47(10):101309.
57. Bondariyan N, Vakhshoori M, Sadeghpour N, Shafie D. Prognostic value of shock index, modified shock index, and age-adjusted derivatives in prediction of in-hospital mortality in patients with acute decompensated heart failure: Persian registry of cardiovascular disease/heart failure study. Anatolian Journal of Cardiology. 2022;26(3):210.
58. Koca A, Polat O, Oğuz AB, Genc S, Günalp M, Değirmenci S, et al. Reliability and validity of a new computer-based triage decision support tool: ANKUTRIAGE. Disaster Medicine and Public Health Preparedness. 2023;17:e162.
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Kardan MR, Torabi M, Saberinia A, Mirzaee M. Vital signs monitoring critically ill patients in traditional triage: room for improvement and innovation. Front Emerg Med. 2026;.
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