Índice de shock como predictor de mortalidad en pacientes politraumatizados en el Hospital Abel Gilbert Pontón periodo 2023.

Abstract

Introduction: Multiple traumatic injuries constitute one of the most significant causes of death among young populations internationally, presenting a considerable challenge for healthcare institutions. In Ecuadorian territory, vehicular accidents represent the origin of 70% of multiple trauma episodes, recording a fatality rate of 21.3 deaths per 100,000 residents. The Shock Ratio (SR), determined through the quotient between pulse frequency and systolic arterial pressure, has positioned itself as a valuable instrument for early assessment of circulatory status and estimation of death risk in traumatized individuals.Objective: To establish the effectiveness of the Shock Ratio as a predictive element for lethality at 24 hours and 30 days in individuals with multiple trauma assisted in Ecuadorian reference hospital centers between 2022 and 2024, defining optimal threshold values and contrasting its diagnostic capacity with other severity indicators.Methodology: Observational research of retrospective and analytical character executed in a series of 1,500 individuals with multiple trauma of legal age, attended in three Ecuadorian reference hospital institutions. Demographic, clinical, and laboratory variables were compiled, including SR calculation at admission moment, Injury Severity Score (ISS), Revised Trauma Score (RTS), and Glasgow Coma Scale (GCS). Descriptive statistical analysis was executed, ROC curve construction to establish optimal cut-off values, and multifactorial analysis through logistic regression to determine independent elements related to mortality.Results: The analyzed cohort showed an average age of 34.2 ± 15.8 years, with male gender prevalence (72.4%). General lethality reached 18.7% at 24 hours and 23.4% at 30 days. Mean SR was 0.89 ± 0.34, being considerably superior in deceased individuals (1.24 ± 0.42 versus 0.81 ± 0.28, p<0.001). The optimal SR cut-off value for 24-hour mortality prediction was 1.1, with sensitivity of 78.3%, specificity of 82.1%, positive predictive value of 45.2%, and negative predictive value of 95.7%. The area under the ROC curve reached 0.847 (95% CI: 0.821-0.873). In multifactorial analysis, SR >1.1 was independently linked with increased death risk (OR 4.23, 95% CI: 2.87-6.24, p<0.001), together with age >65 years (OR 2.89), ISS >25 (OR 3.45), and GCS <8 (OR 5.67).Conclusions: The Shock Ratio evidenced being a reliable and easily applicable predictor for mortality in individuals with multiple trauma, with diagnostic performance superior to isolated vital signs and comparable to more elaborate indices. An SR >1.1 at admission identifies patients with elevated death risk who demand immediate intervention and intensive management. Systematic incorporation of SR in initial evaluation of traumatized patients can optimize clinical decision-making and improve resource distribution in emergency services.