Factors associated with a positive shock index in the prehospital setting after major trauma

Andrews, Tim; Dipnall, Joanna F.; Gabbe, Belinda; Beck, Ben; Cox, Shelley; Cameron, Peter A.

doi:10.1186/s13049-025-01437-9

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Factors associated with a positive shock index in the prehospital setting after major trauma

Tim Andrews, Joanna F. Dipnall, Belinda Gabbe

, Ben Beck, Shelley Cox, Peter A. Cameron

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Volume: 33, Issue: 1, Start page: 122

Swansea University Author: Belinda Gabbe

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DOI (Published version): 10.1186/s13049-025-01437-9

Abstract

BackgroundBleeding and coagulopathy are the leading causes of potentially preventable death and multi-organ damage after injury. Trauma care in the prehospital setting focusses on three key tenets; identification, lifesaving interventions and transport. Existing prehospital trauma triage guidelines...

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Published in:	Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
ISSN:	1757-7241
Published:	Springer Science and Business Media LLC 2025
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70037

first_indexed	2025-07-24T16:13:54Z
last_indexed	2025-07-26T01:59:39Z
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Existing prehospital trauma triage guidelines use a combination of physiological, and patterns of injury to identify potential major trauma, however these guidelines are not designed to identify potential shock.MethodsWe conducted a registry-based cohort study using data from the Victorian State Trauma Registry (VSTR) on adult major trauma patients (≥ 16 years) transported by EMS between 2010 and 2020, including patients within 70 km of Melbourne’s major trauma services. Data from VSTR were linked with the Victorian Ambulance Clinical Information System and operational records from Ambulance Victoria. The primary outcome was shock, defined by a shock index (SI) ≥ 0.9.Logistic regression models stratified by transport mode examined associations with shock. Descriptive statistics and tests of association were used, followed by multivariate logistic regression.ResultsOver this 10-year study, 16,265 patients were identified within 70 km of the major trauma services. 26% of the patients had a shock index ≥ 0.9, and the majority of these patients (88%) were transported by road ambulance. The majority of the patients in this study (69%) were injured within 30 km of the MTS. Females had an increased adjusted odds of shock (aOR = 2.19), as did patients who were entrapped (aOR = 1.23).DiscussionThis study identified that over a quarter of major trauma patients experienced shock during the prehospital phase, with most lacking access to advanced lifesaving interventions typically provided by MICA-flight paramedics. These findings underscore the importance of aligning prehospital care systems with patient needs to optimize trauma outcomes.ConclusionOver 25% of major trauma patients developed a shock index ≥ 0.9 within the prehospital phase of their care. 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spelling	2025-07-24T17:16:36.1868775 v2 70037 2025-07-24 Factors associated with a positive shock index in the prehospital setting after major trauma 4bdcc94332b2bd10530c5e71ceb04f14 0000-0001-7096-7688 Belinda Gabbe Belinda Gabbe true false 2025-07-24 MEDS BackgroundBleeding and coagulopathy are the leading causes of potentially preventable death and multi-organ damage after injury. Trauma care in the prehospital setting focusses on three key tenets; identification, lifesaving interventions and transport. Existing prehospital trauma triage guidelines use a combination of physiological, and patterns of injury to identify potential major trauma, however these guidelines are not designed to identify potential shock.MethodsWe conducted a registry-based cohort study using data from the Victorian State Trauma Registry (VSTR) on adult major trauma patients (≥ 16 years) transported by EMS between 2010 and 2020, including patients within 70 km of Melbourne’s major trauma services. Data from VSTR were linked with the Victorian Ambulance Clinical Information System and operational records from Ambulance Victoria. The primary outcome was shock, defined by a shock index (SI) ≥ 0.9.Logistic regression models stratified by transport mode examined associations with shock. Descriptive statistics and tests of association were used, followed by multivariate logistic regression.ResultsOver this 10-year study, 16,265 patients were identified within 70 km of the major trauma services. 26% of the patients had a shock index ≥ 0.9, and the majority of these patients (88%) were transported by road ambulance. The majority of the patients in this study (69%) were injured within 30 km of the MTS. Females had an increased adjusted odds of shock (aOR = 2.19), as did patients who were entrapped (aOR = 1.23).DiscussionThis study identified that over a quarter of major trauma patients experienced shock during the prehospital phase, with most lacking access to advanced lifesaving interventions typically provided by MICA-flight paramedics. These findings underscore the importance of aligning prehospital care systems with patient needs to optimize trauma outcomes.ConclusionOver 25% of major trauma patients developed a shock index ≥ 0.9 within the prehospital phase of their care. Furthermore, 88% of the shocked patients did not have access to the most advanced prehospital life-saving interventions available within the state. Journal Article Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 33 1 122 Springer Science and Business Media LLC 1757-7241 Trauma, Prehospital; Shock; Lifesaving interventions 9 7 2025 2025-07-09 10.1186/s13049-025-01437-9 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University The VSTR is funded by the Department of Health and Human Services, State Government of Victoria, and Transport Accident Commission. Ben Beck was supported by an Australian Research Council Future Fellowship (FT210100183). Belinda Gabbe was supported by a National Health and Medical Research Council of Australia Investigator Grant (L2, ID 2009998). 2025-07-24T17:16:36.1868775 2025-07-24T17:09:47.3258790 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Tim Andrews 1 Joanna F. Dipnall 2 Belinda Gabbe 0000-0001-7096-7688 3 Ben Beck 4 Shelley Cox 5 Peter A. Cameron 6 70037__34842__2aa000f5bce842dbb32921705c1527ec.pdf 70037.VoR.pdf 2025-07-24T17:14:15.8240918 Output 1890316 application/pdf Version of Record true © The Author(s) 2025. This article is licensed under a Creative Commons Attribution NonCommercial-NoDerivatives 4.0 International License. true eng http://creativecommons.org/licenses/by-nc-nd/4.0/
title	Factors associated with a positive shock index in the prehospital setting after major trauma
spellingShingle	Factors associated with a positive shock index in the prehospital setting after major trauma Belinda Gabbe
title_short	Factors associated with a positive shock index in the prehospital setting after major trauma
title_full	Factors associated with a positive shock index in the prehospital setting after major trauma
title_fullStr	Factors associated with a positive shock index in the prehospital setting after major trauma
title_full_unstemmed	Factors associated with a positive shock index in the prehospital setting after major trauma
title_sort	Factors associated with a positive shock index in the prehospital setting after major trauma
author_id_str_mv	4bdcc94332b2bd10530c5e71ceb04f14
author_id_fullname_str_mv	4bdcc94332b2bd10530c5e71ceb04f14_***_Belinda Gabbe
author	Belinda Gabbe
author2	Tim Andrews Joanna F. Dipnall Belinda Gabbe Ben Beck Shelley Cox Peter A. Cameron
format	Journal article
container_title	Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
container_volume	33
container_issue	1
container_start_page	122
publishDate	2025
institution	Swansea University
issn	1757-7241
doi_str_mv	10.1186/s13049-025-01437-9
publisher	Springer Science and Business Media LLC
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
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description	BackgroundBleeding and coagulopathy are the leading causes of potentially preventable death and multi-organ damage after injury. Trauma care in the prehospital setting focusses on three key tenets; identification, lifesaving interventions and transport. Existing prehospital trauma triage guidelines use a combination of physiological, and patterns of injury to identify potential major trauma, however these guidelines are not designed to identify potential shock.MethodsWe conducted a registry-based cohort study using data from the Victorian State Trauma Registry (VSTR) on adult major trauma patients (≥ 16 years) transported by EMS between 2010 and 2020, including patients within 70 km of Melbourne’s major trauma services. Data from VSTR were linked with the Victorian Ambulance Clinical Information System and operational records from Ambulance Victoria. The primary outcome was shock, defined by a shock index (SI) ≥ 0.9.Logistic regression models stratified by transport mode examined associations with shock. Descriptive statistics and tests of association were used, followed by multivariate logistic regression.ResultsOver this 10-year study, 16,265 patients were identified within 70 km of the major trauma services. 26% of the patients had a shock index ≥ 0.9, and the majority of these patients (88%) were transported by road ambulance. The majority of the patients in this study (69%) were injured within 30 km of the MTS. Females had an increased adjusted odds of shock (aOR = 2.19), as did patients who were entrapped (aOR = 1.23).DiscussionThis study identified that over a quarter of major trauma patients experienced shock during the prehospital phase, with most lacking access to advanced lifesaving interventions typically provided by MICA-flight paramedics. These findings underscore the importance of aligning prehospital care systems with patient needs to optimize trauma outcomes.ConclusionOver 25% of major trauma patients developed a shock index ≥ 0.9 within the prehospital phase of their care. Furthermore, 88% of the shocked patients did not have access to the most advanced prehospital life-saving interventions available within the state.
published_date	2025-07-09T05:28:35Z
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Factors associated with a positive shock index in the prehospital setting after major trauma

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