• Shoma Funabiki, Ryo Yamamoto, Koichiro Homma, Jo Yoshizawa, Siqi Jia, Yukako Takanashi, Reo Kahara, and Junichi Sasaki.
• Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, 160-8582, Shinjuku, Tokyo, Japan.
• Eur J Trauma Emerg Surg. 2024 Apr 1; 50 (2): 561566561-566.

PurposeVital signs are important for predicting clinical outcomes in patients with trauma. However, their accuracy can be affected in older adults because hemodynamic changes are less obvious. This study aimed to examine the usefulness of changes in vital signs during transportation in predicting the need for hemostatic treatments in older patients with trauma.MethodsThis retrospective cohort study was conducted using data from the Japan Trauma Data Bank (2004-2019). Patients aged ≥ 65 years who were hemodynamically stable at the scene were included in this study. The incidence of emergency surgery within 12 h after hospital arrival was compared between patients with delta Shock Index (dSI) > 0.1 and those with dSI ≤ 0.1. Predicting ability was examined after adjusting for patient demographics, comorbidities, vital signs at the scene and on hospital arrival, Injury Severity Score, and abbreviated injury scale in each region.ResultsAmong the 139,242 patients eligible for the study, 3,701 underwent urgent hemostatic surgery within 12 h. Patients with dSI > 0.1 showed a significantly higher incidence of emergency surgery than those with dSI ≤ 0.1 (871/16,549 [5.3%] vs. 2,830/84,250 [3.4%]; odds ratio (OR), 1.60 [1.48-1.73]; adjusted OR, 1.22 [1.08-1.38]; p = 0.001). The relationship between high dSI and a higher incidence of intervention was observed in patients with hypertension and those with decreased consciousness on arrival.ConclusionHigh dSI > 0.1 was significantly associated with a higher incidence of urgent hemostatic surgery in older patients.© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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