Evaluation of the delta shock index as an indicator of outcomes in patients with trauma who did not receive prehospital intravenous fluid infusion: a Japanese, nationwide, database study

Eur J Trauma Emerg Surg. 2025 Nov 25;51(1):343. doi: 10.1007/s00068-025-03013-3.

ABSTRACT

PURPOSE: The delta shock index (DSI) has been proposed as a predictor of outcomes in individuals who have experienced trauma. However, previous studies have not accounted for prehospital medical treatment or intravenous fluid infusion, which can increase systolic blood pressure. This study was performed to clarify the association between baseline DSI and patient outcomes by limiting the data to cases in which patients did not receive prehospital intravenous fluid infusion, and to investigate whether DSI could be a "dynamic" resuscitation marker.

METHODS: This retrospective cohort study used information from the Japan Trauma Data Bank (2019-2022). The study included trauma patients aged ≥ 15 years who had contact only with the fire department's emergency medical services and were transported to a hospital from a prehospital setting. Patients who received prehospital intravenous fluid infusion, those with cardiac arrest, and those with severe head trauma (abbreviated injury scale score ≥ 3) were excluded. The primary endpoint was death within 24 h; the secondary endpoint was death at the time of discharge. A multivariate multiple logistic regression model was used to calculate adjusted odds ratios (aOR) and corresponding 95% confidence intervals (CI) to analyze the associations of these endpoints with DSI.

RESULTS: Data from 40,179 patients were analyzed. A 0.1-unit increase in DSI was significantly associated with 24-h outcome (death; aOR 1.58 [95% CI 1.22-2.04]) and discharge outcome (death; aOR 1.70 [95% CI 1.37-2.11]).

CONCLUSION: DSI may serve as a "dynamic" resuscitation marker and prognostic indicator for predicting patient outcomes.

PMID:41288726 | DOI:10.1007/s00068-025-03013-3