Batsheva Tzadok¹, Stav Soffer², Shay Shapira^2*, Sandra Bushnak¹ and Eran Tal Or¹

Five-level triage is the gold standard in Emergency Departments (ED) worldwide; the Emergency Severity Index (ESI) and Canadian Triage and Acuity Scale (CTA) are the leading systems. The accuracy of these systems is in question with respect to the aging population. We examined Shock Index (SI) and Age-Adjusted Shock Index (AASI) as well as traditional vital signs such as Blood Pressure (BP) and Heart Rate (HR) in patients above age sixty-five. We investigated their association to the need for a Lifesaving Intervention (LSI) or mortality (mort) within 48 hours of presentation to the ED.
This retrospective study examined medical files of patients aged sixty-five and above who presented to the ED during 2015-2017 and were then hospitalized in a medical ward or intensive care unit. We then dichotomized them into two groups, those who required an immediate life-saving intervention and/or mortality within 48 hours (LSI/mort), and those who did not. We searched for a correlation between the need for these interventions/mortality with HR, BP, SI, and AASI.
Using T-test we found a positive correlation between SI and AASI and the need for an LSI/mort. In the non-LSI group, the mean SI was 0.59 compared to 0.66 in LSI/mort group (p = 0.033). AASI mean value was 46 non-LSI compared to 52 with LSI (p = 0.027). In contrast, we found no correlation between HR, systolic blood pressure, and age for prediction of LSI. In the patients who died within 48 hours we found a strong association of elevated SI and AASI. Those who died had a mean SI of 0.83 in contrast to 0.60 in the no mortality cohort (p = 0.004). AASI had a comparable trend: 72 for those with mortality and 47 who survived (p = 0.001).
Our findings support the assertion that there is a need to reconsider which vital signs we use for elder patients within our emergency triage algorithms. We also believe there is a place to consider the incorporation of SI and AASI into ED triage of elder patients.

Cite this Article: Tzadok B, Soffer S, Shapira S, Or ET. Shock Index in the Acute Care Geriatric Patient and its Correlation to the Need of a Life Saving Intervention. Int J Gerontol Geriatr Res. 2019;2(1): 001-004.

Published: 08 January 2019