• Stephen R Odom, Michael D Howell, Alok Gupta, George Silva, Charles H Cook, and Daniel Talmor.
• Department of Surgery, Division of Acute Care Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
• J Emerg Trauma Shock. 2016 Jul 1; 9 (3): 103-6.

ContextWe noted a bimodal relationship between mortality and shock index (SI), the ratio of heart rate to systolic blood pressure.AimsTo determine if extremes of SI can predict mortality in trauma patients.Settings And DesignsRetrospective evaluation of adult trauma patients at a tertiary care center from 2000 to 2012 in the United States.Materials And MethodsWe examined the SI in trauma patients and determined the adjusted mortality for patients with and without head injuries.Statistical Analysis UsedDescriptive statistics and multivariable logistic regression.ResultsSI values demonstrated a U-shaped relationship with mortality. Compared with patients with a SI between 0.5 and 0.7, patients with a SI of <0.3 had an odds ratio for death of 2.2 (95% confidence interval [CI] 21.2-4.1) after adjustment for age, Glasgow Coma score, and injury severity score while patients with SI >1.3 had an odds ratio of death of 3.1. (95% CI 1.6-5.9). Elevated SI is associated with increased mortality in patients with isolated torso injuries, and is associated with death at both low and high values in patients with head injury.ConclusionOur data indicate a bimodal relationship between SI and mortality in head injured patients that persists after correction for various co-factors. The distribution of mortality is different between head injured patients and patients without head injuries. Elevated SI predicts death in all trauma patients, but low SI values only predict death in head injured patients.

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