Factors Predicting Shock in Emergency Patients
Keywords:co-morbidity, Shock Index, emergency patients, Emergency Severity Index, age
Objective: To study the factors of age, comorbidity, time spent on transporting patients to hospital, type of transport service and emergency severity, and their power to predict shock in emergency patients.
Design: Correlational predictive design.
Methodology: The sample was 200 patients with physical illnesses or injuries treated at two suburban tertiary hospitals. Six instruments were used to collect data: 1) a personal information questionnaire; 2) an illness/injury form; 3) a form recording the transport time, transport service type and treatment/care given during transport; 4) a comorbidity assessment form; 5) the Emergency Severity Index (ESI); and 6) the Shock Index (SI). The data were analysed using chi-square and binary logistic regression analysis, with the statistical signifcance level determined at 0.05.
Results: The patients’ average age was 52.04 years (SD = 21.78; range = 18-93 years). Sixty-three percent of the patients were treated for illnesses, and over half (54%) had comorbid diseases. In nearly half of the cases (48.5%), the patients had been transported to hospital by their friends or relatives. In three-fourths of the cases (75.5%), the transporting time had exceeded 60 minutes, and the patients (76.5%) had not received medical treatment or care during transportation. More than half (53.5%) suffered from shock; of these, 43% (SI > 0.8) were already in shock upon admission.
The patients’ shock was found to be correlated with the factors of age, comorbidity, type of transport and symptomatic severity. In addition, emergency severity level 1 (critical) and level 2 (high-risk) displayed signifcant shock-predicting powers, at Nagelkerke R2 = .296 (OR = 35.198, 95% CI = 7.726-160.351, p < 0.01; and OR = 4.545, 95% CI = 1.498-13.786, p < 0.05, respectively).
Recommendations: It is recommended that emergency unit nurses apply the ESI and SI to assessing trauma patients’ emergency severity to prevent shock in patients with physical illnesses and injuries.
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