Usefulness of shock index for prehospital triage of septic shock by the SAMU regulation

Jouffroy R, Saade A, Philippe P, Gueye P, Bloch-Laine E, Ecollan P, Carli P, Vivien B. Usefulness of shock index for prehospital triage of septic shock by the SAMU regulation. Med Emergency, MJEM 2020; 28:58-63.
DOI: 10.26738/MJEM.2017/MJEM28.2020/CT.CRE.150420

Key words: prehospital triage, SAMU regulation, septic shock, shock index

  • Authors’ affiliation
  • Article history / info
  • Conflict of interest statement

Corresponding author: Romain Jouffroy, MD

Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France

Departments of Anesthesia & Clinical Epidemiology and Biostatistics; Michael DeGroote

School of Medicine; Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada

Population Health Research Institute; David Braley Cardiac, Vascular and Stroke Research Institute; Perioperative Medicine and Surgical Research Unit, Hamilton, Ontario, Canada

romain.jouffroy@gmail.com

Jouffroy R, MD1,2,3, Saade A, MD, PhD1, Philippe P, MD1, Gueye P, MD, PhD4, Bloch-Laine E, MD5, Ecollan P, MD6, Carli P, MD, PhD1, Vivien B, MD, PhD1

1. Department of Anesthesia & Intensive Care Unit, SAMU, Hôpital Necker Enfants Malades 149 rue de Sèvres 75015 Paris, University Paris Descartes, France.

2. Department of Anesthesia & Clinical Epidemiology and Biostatistics; Michael DeGroote School of Medicine; Faculty of Health Sciences, McMaster University. Hamilton, Ontario, Canada.

3. Population Health Research Institute; David Braley Cardiac, Vascular and Stroke Research Institute; Perioperative Medicine and Surgical Research Unit; Hamilton, Ontario, Canada.

4. Prehospital Medical System, SAMU de Martinique, University Hospital Pierre Zobda Quitman, Fort-de-France Martinique, France

5. Emergency department, hospital Cochin 24 rue du faubourg saint Jacques, 75014 Paris France and emergency department – SMUR, Hospital Hôtel Dieu 1 place du parvis Notre-Dame 75004 Paris, France.

6. Intensive Care Unit, SMUR, Pitie Salpetrière Hospital, 47 boulevard de l’Hôpital 75013 Paris, France.

Category: Case report

Received: Dec. 18, 2019

Revised: Feb. 12, 2020

Accepted: Apr. 15, 2020

There is no conflict of interest to declare

ABSTRACT

Introduction: Scoring systems were developed for risk-stratification of septic shock (SS) patients but their performance is poor in the prehospital setting.

Objective: The aim of this study was to evaluate the ability of the shock index (SI) in prehospital triage of SS patients to predict their admission in intensive care unit (ICU).

Methods: We performed a two months retrospective study of call records received by the Paris SAMU 75 regulation centerconcerning patients with presumed SS. The outcome was the in-ICU admission.

Results: Among the 30 642 calls received, 140 concerned patients with presumed SS were included. Twenty-two patients (16%) were admitted to ICU and 118 (84%) to the emergency department. The area under the curve (AUC) of the SI was 0.76 [0.65-0.86]. Using a threshold for SI > 0.9, the sensitivity was 82%, the specificity was 67%, the positive predictive value was 32% and the negative predictive value was 95%. After logistic regression analysis, the OR for SI > 0.9 reached 7.65 [2.33- 35.00]. Using propensity score analysis, the odd-ratio (OR) for SI > 0.9 was 1.34 [1.15-1.52]. Results are expressed by OR with 95 percent confidence interval [95 CI].

Conclusion: Shock index is a reliable tool for risk stratification of SS patients managed in the prehospital setting. Using a threshold of one for the SI helps the screening of patients requiring ICU admission by the SAMU 15 regulation call centre. Prospective studies including SI in the decision-making process in the prehospital triage of SS patients are needed to validate these results.

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