{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:45:52Z","timestamp":1786999552846,"version":"build-2736575974"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"unspecified","delay-in-days":1,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Prehosp. Disaster med."],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1049023X24000207_as1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1049023X24000207_as2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included data from patients \u226515 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients with vital signs of zero were excluded. Documented prehospital and emergency department (ED) vital signs included systolic pressure, heart rate, respiratory rate, and calculated shock index (SI). The area under the receiver operator curves (AUROC) was used to assess the accuracy of these variables for predicting 24-hour survival. Optimal thresholds to predict mortality were identified using Youden\u2019s Index, 90% specificity, and 90% sensitivity. Additional analyses examined patients 70+ years of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1049023X24000207_as3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>There were 1,439,221 subjects in the 2019-2020 datasets that met inclusion for this analysis with &lt;0.1% (10,270) who died within 24 hours. The optimal threshold for prehospital systolic pressure was 110, pulse rate was 110, SI was 0.9, and respiratory rate was 15. The optimal threshold for the ED systolic was 112, pulse rate was 107, SI was 0.9, and respiratory rate was 21. Among the elderly sub-analysis, the optimal threshold for prehospital systolic was 116, pulse rate was 100, SI was 0.8, and respiratory rate was 21. The optimal threshold for ED systolic was 121, pulse rate was 95, SI was 0.8, and respiratory rate was 21.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1049023X24000207_as4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Systolic blood pressure (SBP) and SI offered the best predictor of mortality among trauma patients. The SBP values predictive of mortality were significantly higher than the traditional 90mmHg threshold. This dataset highlights the need for better methods to guide resuscitation as initial vital signs have limited accuracy in predicting subsequent mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1049023x24000207","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T10:12:17Z","timestamp":1712052737000},"page":"151-155","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":4,"title":["Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study"],"prefix":"10.1017","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-441X","authenticated-orcid":false,"given":"Michael D.","family":"April","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew D.","family":"Fisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Rizzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franklin L.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Winkle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2322-5216","authenticated-orcid":false,"given":"Steven G.","family":"Schauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"S1049023X24000207_ref25","unstructured":"25. Nissley, LE , Rodriguez, R , April, MD , Schauer, SG , Stevens, GJ. Occam\u2019s Razor and prehospital documentation: when the simpler solution resulted in better documentation. Med J (Ft Sam Houst Tex). 2023;(Per 23-1\/2\/3):81-86."},{"key":"S1049023X24000207_ref19","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003050"},{"key":"S1049023X24000207_ref8","unstructured":"8. American College of Surgeons (ACS). Advanced Trauma Life Support Student Course Manual, 10th edition. Chicago, Illinois USA: ACS; 2018."},{"key":"S1049023X24000207_ref27","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000000062"},{"key":"S1049023X24000207_ref3","doi-asserted-by":"publisher","DOI":"10.1017\/S1049023X17006422"},{"key":"S1049023X24000207_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2010.10.012"},{"key":"S1049023X24000207_ref6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32233-0"},{"key":"S1049023X24000207_ref28","doi-asserted-by":"publisher","DOI":"10.1007\/s00247-017-4065-9"},{"key":"S1049023X24000207_ref4","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900412"},{"key":"S1049023X24000207_ref5","unstructured":"5. Schauer, SG , April, MD , Naylor, JF , et al. A descriptive analysis of data from the Department of Defense Joint Trauma System Prehospital Trauma Registry. US Army Med Dep J. 2017;(3-17):92-97."},{"key":"S1049023X24000207_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16498"},{"key":"S1049023X24000207_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2020.05.012"},{"key":"S1049023X24000207_ref12","first-page":"291","article-title":"Hypotension begins at 110 mmHg: redefining \u201chypotension\u201d with data","volume":"63","author":"Eastridge","year":"2007","journal-title":"J Trauma."},{"key":"S1049023X24000207_ref9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199410273311701"},{"key":"S1049023X24000207_ref24","unstructured":"24. Sorensen, DA , April, MD , Fisher, AD , Schauer, SG. An analysis of the shock index and pulse pressure as a predictor for massive transfusion and death in US and Coalition Iraq and Afghanistan. Med J (Ft Sam Houst Tex). 2021;(PB 8-21-07\/08\/09):63-68."},{"key":"S1049023X24000207_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6109(05)70474-6"},{"key":"S1049023X24000207_ref26","first-page":"33","article-title":"Validation of the age-adjusted shock index for pediatric casualties in Iraq and Afghanistan","volume":"7","author":"Cuenca","year":"2020","journal-title":"Mil Med Res."},{"key":"S1049023X24000207_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.07.007"},{"key":"S1049023X24000207_ref18","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16975"},{"key":"S1049023X24000207_ref17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2012.08.017"},{"key":"S1049023X24000207_ref2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e3182755dcc"},{"key":"S1049023X24000207_ref14","first-page":"1426","article-title":"Utility of the shock index in predicting mortality in traumatically injured patients","volume":"67","author":"Cannon","year":"2009","journal-title":"J Trauma."},{"key":"S1049023X24000207_ref11","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usaa197"},{"key":"S1049023X24000207_ref7","doi-asserted-by":"publisher","DOI":"10.55460\/D4C5-PVHK"},{"key":"S1049023X24000207_ref15","doi-asserted-by":"publisher","DOI":"10.4103\/1947-2714.141632"},{"key":"S1049023X24000207_ref10","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2013.0665"},{"key":"S1049023X24000207_ref23","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000239508.94330.7a"},{"key":"S1049023X24000207_ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2023.08.040"},{"key":"S1049023X24000207_ref16","doi-asserted-by":"publisher","DOI":"10.1097\/JTN.0000000000000436"}],"updated-by":[{"DOI":"10.1017\/s1049023x24000384","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000}}],"container-title":["Prehospital and Disaster Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1049023X24000207","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T23:34:36Z","timestamp":1727739276000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1049023X24000207\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4]]},"references-count":29,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["S1049023X24000207"],"URL":"https:\/\/doi.org\/10.1017\/s1049023x24000207","relation":{},"ISSN":["1049-023X","1945-1938"],"issn-type":[{"value":"1049-023X","type":"print"},{"value":"1945-1938","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4]]},"assertion":[{"value":"\u00a9 US Department of Defense, 2024","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is a work of the US Government and is not subject to copyright protection within the United States. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}