Anto Tiju, G (2023) Modified Shock Index as an Indicator of Morbidity and Mortality in Trauma Patients. Masters thesis, Madras Medical College, Chennai.
Full text not available from this repository.Abstract
INTRODUCTION: The most frequent cause of shock in trauma victims is haemorrhage. Fluid changes within the body's fluid compartments, especially in the extracellular fluid compartment, make the trauma patient's reaction to blood loss more complicated. Even little bleeding can cause changes of fluid to the extracellular compartment after soft tissue damage. It is important to take these fluid changes into account while analysing the reaction to blood loss. Also take into account the pathophysiologic effects of resuscitation and reperfusion as well as the changes brought on by severe, persistent shock. The goal of triage in the emergency department is to identify patients in critical condition who require immediate treatment and separate them from those who do not. An experienced nurse triages patient in most hospitals based on vital signs, age, level of consciousness, and presenting complaints. We are evaluating a simple marker that can be easily used to predict the outcome of emergency patients, which could be extremely useful in triage. OBJECTIVES PRIMARY OBJECTIVE: To analyse the predictive value of Modified Shock Index in mortality and morbidity of Trauma patients. SECONDARY OBJECTIVES: 1. To predict the MSI beyond which there is necessity for blood transfusion. 2.To arrive at the MSI beyond which mortality rate increases 3. To predict the MSI beyond which requirement of Intensive Care admission increases. MATERIALS & METHODS: STUDY DESIGN AND SETTING: A prospective observational study conducted in the Emergency and Trauma Ward of Rajiv Gandhi Government General Hospital. The period of study is between June 2022 to December 2022. ETHICS STATEMENT: This study was approved by the institutional human ethics committee and institutional review board of Madras Medical College. Data confidentiality was maintained and written informed consent was obtained from the patients. STUDY POPULATION: The study participants were patients presenting with features of shock to the emergency department. INCLUSION CRITERIA: 1. All patients of age >12 years, irrespective of their sex admitted following trauma. 2. Patients primarily received in RGGGH following trauma. 3. Acceptance of informed consent. EXCLUSION CRITERIA: 1. Age <12 years. 2. Trauma patients who had underwent primary intervention in other hospitals. 3. Refusal for consent SAMPLE SIZE MSI <0.7 and >1.3 had higher odds of mortality as compared to other predictors according a study of Singh et al. Based on the above parameter with an alpha of 0.05 (2 sided) and power of 95% and assuming proportion of disease and correlation is 0.5 the estimated sample size using the sample size formula for Regression methods - Multiple logistic regression is 213. STUDY PROTOCOL All patients satisfying the Inclusion and Exclusion criteria were included in the study. Upon arrival, patients are examined after analysing the mode of trauma. Vital parameters including Heart Rate, Systolic Blood Pressure, Diastolic Blood Pressure are recorded immediately on arrival of patient in Emergency ward. Modified Shock Index on arrival is calculated. Patient is started on necessary blood products when warranted and closely monitored with vital parameters, ECG, arterial blood gas analysis and other radiological investigations as per protocol on ATLS guidelines. Patients are reassessed after 6 hours with vital parameters and necessity for ICU admission is included. An analysis was made with the available values, cut off points, ICU stay and mortality of the patients. CONCLUSION Hemorrhagic shock is the type of shock most often seen in severe trauma patients, and its early identification is crucial to patient prognosis. This study shows both shock indices to offer good massive bleeding predicting capacity, and the results obtained are comparable to those of other studies that describe SI and MSI as potentially useful for the identification of hemorrhagic shock MSI is a good predictor of morbidity and mortality in trauma and is easy to apply during initial management of severe trauma. The cut-off value derived for Modfied Shock Index in trauma patients in this study is 1.3, beyond which mortality and morbidity serially rises. In our study patients with MSI >1.68 required blood transfusion and those patients with MSI <1.29 did not necessitate blood transfusion. MSI > 1.92 needed ICU care and mortality rate was high when MSI > 2.35.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 220120100504 |
| Uncontrolled Keywords: | Modified Shock Index, Indicator, Morbidity, Mortality, Trauma Patients. |
| Subjects: | MEDICAL > General Surgery > MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 15 Jan 2024 01:43 |
| Last Modified: | 19 Jan 2024 15:56 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/21294 |
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