A pragmatic clinical definition of traumatic shock using systolic blood pressure and shock index: A national registry study.
Hospital-arrival systolic BP ≤90 mmHg linked to over four times higher in-hospital trauma mortality.
A pragmatic clinical definition of traumatic shock using systolic blood pressure and shock index: A national registry study.
Traumatic shock (traumatic shock) is implicated in up to 40% of early trauma deaths; however, no consensus definition exists, and its epidemiology and outcomes have not been characterised at a population level in Australia.
To apply a pragmatic clinical definition of traumatic shock, based on systolic blood pressure (SBP) and shock index (shock index), to a national trauma registry, and to describe the epidemiology and outcomes of major trauma (major trauma) patients with and without clinical signs of shock.
A retrospective cohort study was conducted using Australia New Zealand Trauma Registry (Australia New Zealand Trauma Registry) data (2017-2022).
systolic BP 90 or under at arrival means far higher risk of dying in hospital
Among 47,730 adult major trauma patients in the hospital arrival analysis, 16,463 (34.5%) were excluded from the pre-hospital analysis due to incomplete centre-level data.
Patients with pre-hospital or hospital arrival signs of traumatic shock were younger, more severely injured, and more likely to sustain penetrating trauma.
ED mortality differences, although associated with very large odds ratios, were small in absolute terms given the low baseline (h-SBP ≤90 mmHg: ARD 5.6%, RR 25.0, OR 26.5).
A stepwise relationship between decreasing hospital arrival SBP and mortality was observed across thresholds of ≤ 100, ≤ 90, and ≤ 80 mmHg.
A pragmatic clinical definition of traumatic shock using SBP and shock index identified a major trauma subgroup with substantially higher mortality and resource use.
Although unadjusted analyses limit causal inference, this descriptive study provides a foundation for future validation and prospective research, while highlighting important gaps in national trauma registry data quality.