Journal Article

Reverse shock index multiplied by simplified motor score as a predictor of clinical outcomes for patients with COVID-19

Chung, Jui-Yuan, Yiang, Giou-Teng, Hou, Yueh-Tseng, Wu, Meng-Yu

2024

Overview

Background The reverse shock index (rSI) combined with the Simplified Motor Score (sMS), that is, the rSI-sMS, is a novel and efficient prehospital triage scoring system for patients with COVID-19. In this study, we evaluated the predictive accuracy of the rSI-sMS for general ward and intensive care unit (ICU) admission among patients with COVID-19 and compared it with that of other measures, including the shock index (SI), modified SI (mSI), rSI combined with the Glasgow Coma Scale (rSI-GCS), and rSI combined with the GCS motor subscale (rSI-GCSM). Methods All patients who visited the emergency department of Taipei Tzu Chi Hospital between January 2021 and June 2022 were included in this retrospective cohort. A diagnosis of COVID-19 was confirmed through a SARS-CoV-2 reverse-transcription polymerase chain reaction test or SARS-CoV-2 rapid test with oropharyngeal or nasopharyngeal swabs and was double confirmed by checking International Classification of Diseases, Tenth Revision, Clinical Modification codes in electronic medical records. In-hospital mortality was regarded as the primary outcome, and sepsis, general ward or ICU admission, endotracheal intubation, and total hospital length of stay (LOS) were regarded as secondary outcomes. Multivariate logistic regression was used to determine the relationship between the scoring systems and the three major outcomes of patients with COVID-19, including. The discriminant ability of the predictive scoring systems was investigated using the area under the receiver operating characteristic curve, and the most favorable cutoff value of the rSI-sMS for each major outcome was determined using Youden’s index. Results After 74,183 patients younger than 20 years ( n  = 11,572) and without COVID-19 ( n  = 62,611) were excluded, 9,282 patients with COVID-19 (median age: 45 years, interquartile range: 33–60 years, 46.1% men) were identified as eligible for inclusion in the study. The rate of in-hospital mortality was determined to be 0.75%. The rSI-sMS scores were significantly lower in the patient groups with sepsis, hyperlactatemia, admission to a general ward, admission to the ICU, total length of stay ≥ 14 days, and mortality. Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS exhibited a significantly higher accuracy for predicting general ward admission, ICU admission, and mortality but a similar accuracy to that of the rSI-GCS. The optimal cutoff values of the rSI-sMS for predicting general ward admission, ICU admission, and mortality were calculated to be 3.17, 3.45, and 3.15, respectively, with a predictive accuracy of 86.83%, 81.94%%, and 90.96%, respectively. Conclusions Compared with the SI, mSI, and rSI-GCSM, the rSI-sMS has a higher predictive accuracy for general ward admission, ICU admission, and mortality among patients with COVID-19.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Accuracy / Antigens / Blood pressure / Care and treatment / Clinical outcomes / Cohort analysis / Comparative analysis / Consciousness / COVID-19 / COVID-19 - diagnosis / Electronic health records / Electronic medical records / Emergency medical care / Emergency Medicine / Emergency Service, Hospital / Female / Hemodynamics / Hospitals / Humans / Hyperlactatemia / Intensive Care Units / Intubation / Male / Medical records / Medicine / Medicine & Public Health / Middle Aged / Mortality / Normal distribution / Patient outcomes / Patients / Retrospective Studies / Reverse shock index combined with the GCS motor subscale / Reverse shock index combined with the Glasgow Coma Scale / Reverse shock index combined with the simplified motor score / SARS-CoV-2 / Sepsis / Severe acute respiratory syndrome coronavirus 2 / Shock / Shock index / Trauma / United Kingdom / Variables / Ventilators / Vital signs