Background: A new classification of hypovolemic shock based on the shock index (SI) was proposed in 2013. This\nclassification contains four classes of shock and shows good correlation with acidosis, blood product need and mortality.\nSince their applicability was questioned, the aim of this study was to verify the validity of the new classification in\nmultiple injured patients with traumatic brain injury.\nMethods: Between 2002 and 2013, data from 40 888 patients from the TraumaRegister DGU�® were analysed. Patients\nwere classified according to their initial SI at hospital admission (Class I: SI < 0.6, class II: SI â�¥0.6 to <1.0, class III SI â�¥1.0 to\n<1.4, class IV: SI â�¥1.4). Patients with an additional severe TBI (AIS â�¥ 3) were compared to patients without severe TBI.\nResults: 16,760 multiple injured patients with TBI (AIShead â�¥3) were compared to 24,128 patients without severe TBI.\nWith worsening of SI class, mortality rate increased from 20 to 53% in TBI patients. Worsening SI classes were\nassociated with decreased haemoglobin, platelet counts and Quickâ��s values. The number of blood units transfused\ncorrelated with worsening of SI. Massive transfusion rates increased from 3% in class I to 46% in class IV. The accuracy\nfor predicting transfusion requirements did not differ between TBI and Non TBI patients.\nDiscussion: The use of the SI based classification enables a quick assessment of patients in hypovolemic shock based\non universally available parameters. Although the pathophysiology in TBI and Non TBI patients and early treatment\nmethods such as the use of vasopressors differ, both groups showed an identical probability of recieving blood\nproducts within the respective SI class.\nConclusion: Regardless of the presence of TBI, the classification of hypovolemic shock based on the SI enables a fast\nand reliable assessment of hypovolemic shock in the emergency department. Therefore, the presented study supports\nthe SI as a feasible tool to assess patients at risk for blood product transfusions, even in the presence of severe TBI.
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