Use of the shock index to predict maternal outcomes in women referred for postpartum hemorrhage

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2 Citations (Scopus)

Abstract

Objective: To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH). Methods: This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results: 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval [CI] 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures. Conclusion: The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.

Original languageEnglish
JournalInternational Journal of Gynecology and Obstetrics
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Postpartum Hemorrhage
Vital Signs
Shock
Mothers
Blood Pressure
ROC Curve
Heart Rate
Confidence Intervals
Korea
Intensive Care Units
Retrospective Studies
Morbidity
Sensitivity and Specificity

Keywords

  • Intensive care unit
  • Massive transfusion
  • Postpartum hemorrhage
  • Referred
  • Shock index
  • Vital sign

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

Cite this

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title = "Use of the shock index to predict maternal outcomes in women referred for postpartum hemorrhage",
abstract = "Objective: To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH). Methods: This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results: 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95{\%} confidence interval [CI] 0.727–0.883). A shock index greater than 0.9 had 93.8{\%} (95{\%} CI 69.8–99.8) sensitivity and 51.2{\%} (35.1–67.1) specificity for prediction of massive transfusion, and 93.6{\%} (78.6–99.2) sensitivity and 31.0{\%} (15.3–50.8) specificity for prediction of invasive procedures. Conclusion: The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.",
keywords = "Intensive care unit, Massive transfusion, Postpartum hemorrhage, Referred, Shock index, Vital sign",
author = "Lee, {Se Young} and Kim, {Ho Yeon} and Geum-Joon Cho and Hong, {Soon Cheol} and Oh, {Min Jeong} and Kim, {Hai Joong}",
year = "2018",
month = "1",
day = "1",
doi = "10.1002/ijgo.12714",
language = "English",
journal = "International Journal of Gynecology and Obstetrics",
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publisher = "Elsevier Ireland Ltd",

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T1 - Use of the shock index to predict maternal outcomes in women referred for postpartum hemorrhage

AU - Lee, Se Young

AU - Kim, Ho Yeon

AU - Cho, Geum-Joon

AU - Hong, Soon Cheol

AU - Oh, Min Jeong

AU - Kim, Hai Joong

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH). Methods: This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results: 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval [CI] 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures. Conclusion: The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.

AB - Objective: To evaluate the clinical significance of various vital signs in women referred for postpartum hemorrhage (PPH). Methods: This retrospective study included patients with primary PPH who were referred to Korea University Medical Center, Ansan, between January 1, 2004, and December 31, 2016. We analyzed data for systolic and diastolic blood pressure, heart rate, and shock index (heart rate divided by systolic blood pressure) at time of arrival. Significant morbidity, such as massive transfusion, invasive procedures, and admission to the intensive care unit were reviewed. We used the area under the receiver operating characteristic curve (AUROC) for each vital sign to predict adverse maternal outcomes. Sensitivity, specificity, and negative and positive predictive values were assessed. Results: 118 women with PPH were identified. The shock index had the highest AUROC to predict massive transfusion (0.815, 95% confidence interval [CI] 0.727–0.883). A shock index greater than 0.9 had 93.8% (95% CI 69.8–99.8) sensitivity and 51.2% (35.1–67.1) specificity for prediction of massive transfusion, and 93.6% (78.6–99.2) sensitivity and 31.0% (15.3–50.8) specificity for prediction of invasive procedures. Conclusion: The shock index has significant ability to predict adverse outcomes of PPH compared with other initial vital signs when patients are referred.

KW - Intensive care unit

KW - Massive transfusion

KW - Postpartum hemorrhage

KW - Referred

KW - Shock index

KW - Vital sign

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