• L J Terceros-Almanza, C García-Fuentes, S Bermejo-Aznárez, I J Prieto-Del Portillo, C Mudarra-Reche, I Sáez-de la Fuente, and M Chico-Fernández.
• Unidad de Trauma y Emergencias, Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: luchoter000@hotmail.com.
• Med Intensiva. 2017 Dec 1; 41 (9): 532-538.

ObjectiveTo determine the predictive value of the Shock Index and Modified Shock Index in patients with massive bleeding due to severe trauma.DesignRetrospective cohort.SettingSevere trauma patient's initial attention at the intensive care unit of a tertiary hospital.SubjectsPatients older than 14 years that were admitted to the hospital with severe trauma (Injury Severity Score >15) form January 2014 to December 2015.VariablesWe studied the sensitivity (Se), specificity (Sp), positive and negative predictive value (PV+ and PV-), positive and negative likelihood ratio (LR+ and LR-), ROC curves (Receiver Operating Characteristics) and the area under the same (AUROC) for prediction of massive hemorrhage.Results287 patients were included, 76.31% (219) were male, mean age was 43,36 (±17.71) years and ISS was 26 (interquartile range [IQR]: 21-34). The overall frequency of massive bleeding was 8.71% (25). For Shock Index: AUROC was 0.89 (95% confidence intervals [CI] 0.84 to 0.94), with an optimal cutoff at 1.11, Se was 91.3% (95% CI: 73.2 to 97.58) and Sp was 79.69% (95% CI: 74.34 to 84.16). For the Modified Shock Index: AUROC was 0.90 (95% CI: 0.86 to 0.95), with an optimal cutoff at 1.46, Se was 95.65% (95% CI: 79.01 to 99.23) and Sp was 75.78% (95% CI: 70.18 to 80.62).ConclusionShock Index and Modified Shock Index are good predictors of massive bleeding and could be easily incorporated to the initial workup of patients with severe trauma.Copyright © 2017 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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