Incidence of Shock in Patients Treated in an Emergency Department after Sustaining a Road Traffic Injury

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Petcharat Eiamla-or
Orapan Thosingha
Suporn Danaidutsadeekul
Chukiat Viwatwongkasem
Kathy Hegadoren


            Road traffic injuries in Thailand are the major cause of death and disabilities in young adults. The presence of shock plays an important role in clinical outcomes.This cross-sectional study aimed to determine the incidence of shock and to identify factors predicting the presence of shock on discharge from the emergency department in patients sustaining moderate to serious road traffic injuries in Thailand. Five hundred and three patients (N=503),who scored at least 16 on the Injury Severity Score on admission to an emergency department were recruited.Population and contextual variables were collected from patients’ medical records and patients and triage nurses’ interviews. Two standardized tools were used to measure the severity of injury and the presence of shock.Data analyses included descriptive statistics, univariate analysis and multivariate logistical regression.
               Results indicated that the majority of patients were males, wearing no safety devices and had consumed alcohol prior to driving their motorcycle. The incidence of shock on discharge from the emergency department to the operating room, intensive care unit or general ward was 35%. Transport time, injury severity, shock on arrival and time spent in the emergency department all made significant contributions to whether patients were in shock on discharge from the emergency department. Our findings suggest that emergency nurses should perform routine ongoing calculation of Modified Shock Index scores for monitoring the moderately to severely injured.Further studies examining the superiority of the Modified Shock Index over cardiorespiratory parameters alone could provide evidence to consider the inclusion of this Index into best practice guidelines.

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Eiamla-or P, Thosingha O, Danaidutsadeekul S, Viwatwongkasem C, Hegadoren K. Incidence of Shock in Patients Treated in an Emergency Department after Sustaining a Road Traffic Injury. PRIJNR [Internet]. 2020 Sep. 16 [cited 2022 Sep. 30];24(4):436-47. Available from:
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World Health Organization. Global status report on road safety 2018. [cited 2019 Sep 5] Available from: https://

World Health Organization. Road safety institutional and legal assessment Thailand. [cited 2019 Sep 5] Available


World Health Organization. Harm to others from drinking:patterns in nine societies. [cited 2019 Nov 5] Available


Stephan K, Kelly M, Mcclure R, Seubsman S, Yiengprugsawan V, Bain C. Distribution of transport injury and related risk behaviors in a large national cohort of Thai adults. Accid Anal Prev 2011;43(3):1062-7. doi:


Mirhaghi A, Heydari A, Mazlom R, Ebrahimi M. The reliability of the Canadian triage and acuity scale: meta-analysis. N Am J Med Sci 2015;7(7):299-305.doi:10.4103/1947-2714.161243.

Lilitsis E, Xenaki S, Athanasakis E, Papadakis E, Syrogianni P, Chalkiadakis G, et al. Guiding management in severe

trauma: reviewing factors predicting outcome in vastly injured patients. J Emerg Trauma Shock 2018;11(2):80-7.

doi: 10.4103/JETS.JETS_74_17

Shiryazdi SM, Mirshamsi M, Piri-Ardekani HR, Shiryazdi SA. Relationship between shock index and clinical outcome

in patients with multiple traumas. IMMINV 2017;2(3):94-6.

Singh A, Ali S, Agarwal A, Srivastava RN. Correlation of shock index and modified shock index with the outcome

of adult trauma patients: A prospective study of 9860 patients. N Am J Med Sci 2014;6(9):450-2. PMID:25317389. doi:10.4103/1947-2714.141632.

Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Weaknesses and capacities affecting the

prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a

cross-sectional study. BMC Emerg Med 2017;17(1):29.doi:10.1186/s12873-017-0137-2.

Funder KS, Petersen JA, Steinmetz J. On-scene time and outcome after penetrating trauma: an observational study. Emerg Med J. 2011 Sep; 28(9):797-801. PMID:20935332. doi: 10.1136/emj.2010.097535.

Bakke HK, Steinvik T, Eidissen S‐I, Gilbert M, Wisborg T. Bystander first aid in trauma – prevalence and quality:

a prospective observational study. Acta Anaesthesiol Scand 2015 Oct; 59(9): 1187-93. PMID: 26088860. doi:10.1111/aas.12561

Pallavisarji U, Gururaj G, Girish RN. Practice and perception of first aid among lay first responders in a southern district of India. Arch Trauma Res 2013; 1(4): 155-60. PMID:24396770. doi: 10.5812/atr.7972

Gauss T, Ageron FX, Devaud ML, Debaty G, Travers S, Garrigue D, et al. Association of prehospital time to inhospital trauma mortality in a physician-staffed emergency medicine system. JAMA Surg 2019 Sep 25. [Epub ahead

of print] PMID: 31553431. doi: 10.1001/jamasurg.2019.3475. Published online September 25, 2019.

Burström L, Nordberg M, Örnung G, Castrén M, Wiklund T, Engström M, et al. Physician-led team triage based on

lean principles may be superior for efficiency and quality? A comparison of three emergency departments with different riage models. Scand J Trauma Resusc Emerg Med 2012 Aug 20; 20(1):57. PMID: 22905993. doi: 10.1186/


Becker JB, Lopes MC, Pinto MF, Campanharo CR, Barbosa DA, Batista RE. Triage at the emergency department:

Association between triage levels and patient outcome. Rev Esc Enferm USP 2015; 49(5):783-9. PMID: 26516748. doi: 10.1590/S0080-623420150000500011.

Alexander D, Abbott L, Zhou Q, Staff I. Can triage nurses accurately predict patient dispositions in the emergency

department? J Emerg Nurs 2016; 42(6): 513-8. PMID:27637406 doi: 10.1016/j.jen.2016.05.008.

Soontorn T, Sitthimongkol Y, Thosingha O, Viwatwongkasem C. Factors influencing the accuracy of triage by registered nurses in trauma patients. Pacific Rim Int J Nurs R 2018;22(2): 120-30.

Shiryazdi SM, Mirshamsi M, Piri-Ardekani HR, Shiryazdi SA. Relationship between shock index and clinical outcome in patients with multiple traumas. IMMINV 2017; 2(3):94-6.

Gruartmoner G, Mesquida J, Ince C. Fluid therapy and the hypovolemic microcirculation. Curr Opin Crit Care 2015;

(4): 276-84. PMID: 26103148. doi: 10.1097/MCC.0000000000000220.

Cannon JW. Hemorrhagic shock. N Engl J Med 2018;378: 370-9. doi: 10.1056/NEJMra1705649.

Wang IJ, Bae BK, Park SW, Cho YM, Lee DS, Min MK, et al. Pre-hospital modified shock index for prediction of

massive transfusion and mortality in trauma patients. Am J Emerg Med 2019 Feb 1. pii: S0735-6757(19)30034-8.

[Epub ahead of print]. doi: 10.1016/j.ajem.2019.01.056.

Abreu G, Azevedo P, Braga CG, Vieira C, Pereira MÁ, Martins J, et al. Modified shock index: A bedside clinical

index for risk assessment of ST-segment elevation myocardial infarction at presentation. Rev Port Cardiol 2018; 37(6): 481-8. PMID: 29807676

Elbaih AH, Houssein AM. Validity of shock index, modified shock index, central venous pressure, and inferior

vena cava collapsibility index in evaluation of intravascular volume among hypovolemic Egyptian patients. IJDI

;4(1),5-13. doi:10.5455/ajdi.20180318114502

Bhuvanenswari T, Devaraj B. Evaluation of modified shock index and mortality rate of patients at emergency department of tertiary care hospital in Tamil Nadu. IAIM 2017;4(11):47-51.

Seesen M, Siviroj P, Sapbamrer R, Morarit S. High blood alcohol concentration associated with traumatic brain injury among traffic injury patients during New Year festivals in Thailand. Traffic Injury Prevention 2019;20(2):115-21.


Anderson R. Revisiting the behavioral model and access to medical care: Does it matter? J Health and Social Behav. 1995; 36(1): 1-10. Available from:

Babitsch B, Gohl D, von Lengerke T. Re-revisiting Andersen’s Behavioral Model of Health services Use: a systematic review of studies from 1998-2011. Psychosoc Med 2012; 9: 1-15. PMID: 23133505. doi: 10.3205/psm000089. Epub 2012 Oct 25.

Boyd CR, Tolson MA, Copes WS. Evaluating trauma care: The TRISS method. trauma score and the injury severity

score. J of Trauma 1987; 27(4):370-80.

Ebrahimi M, Pirazghandi H, Reihani H. How is the injury severity scored? A brief review of scoring systems. RCM

;2(3):125-8. doi: 10.17463/RCM.2015.03.004

Viwatwongkasem C. Sample size determination for research. J Health Res. 1994;8(2):121-46.

Gill M, Martens K, Lynch EL, Salih A, Green SM. Interrater reliability of 3 simplified neurologic scales applied to adults presenting to the emergency department with altered levels of consciousness. Ann Emerg Med 2007 Apr; 49(4):403-7.e1. PMID: 17141146. doi: 10.1016/j.annemergmed. 2006.03.031

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974 Jul 13; 2(7872):81-4. PMID: 4136544. doi: 10.1016/s0140-6736 (74)91639-0

Rennie CP, Brady PC. Advances in injury severity scoring. J Emerg Nurs 2007;33(2):179-81. PMID: 17379041 doi: 10.1016/j.jen.2006.12.006

Celik S, Dursun R, Aycan A, Gönüllü H, Adanaş C, Eryılmaz M, et al. The dynamics of prehospital/hospital care

and modes of transport during civil conflict and terrorist incidents. Public Health 2017;152: 108–16. PMID:

doi: 10.1016/j.puhe.2017.07.029.

Fleischman RJ, Mann NC, Dai M, Ewen Wang N, Jason H, Renee YH, et al. Validating the use of ICD-9 code mapping

to generate injury severity scores. J Trauma Nurs 2017;24(1):4-14. PMID: 28033134. doi:10.1097/JTN.0000000000000255.

Cecconi M, De D B, Antonelli M, Richard B, Jan B, Christoph H, et al. Consensus on circulatory shock and

hemodynamic monitoring: Task force of the European society of intensive care medicine. Intensive Care Med

;40(12):1795-815. PMID: 25392034. doi:10.1007/s00134-014-3525-z

Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. Trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367(26): 2471-81. PMID: 23234472. doi: 10.1056/NEJMoa 1207363

Rogers A, Rogers FB, Schwab CW, Bradburn E, Lee J, Wu D, et al. Increased mortality with undertriaged patients

in a mature trauma center with an aggressive trauma team activation system. Eur J Trauma Emerg Surg 2013 Dec;

(6):599-603. PMID: 26815543. doi: 10.1007/s00068-013-0289-z.

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