{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:22:50Z","timestamp":1790792570753,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2014,12,26]],"date-time":"2014-12-26T00:00:00Z","timestamp":1419552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1086138"],"award-info":[{"award-number":["OPP1086138"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,1]]},"abstract":"Objectives<\/jats:title>To compare the predictive value of the shock index (SI<\/jats:styled-content>) with conventional vital signs in postpartum haemorrhage (PPH<\/jats:styled-content>), and to establish \u2018alert\u2019 thresholds for use in low\u2010resource settings.<\/jats:p><\/jats:sec>Design<\/jats:title>Retrospective cohort study.<\/jats:p><\/jats:sec>Setting<\/jats:title>UK<\/jats:styled-content> tertiary centre.<\/jats:p><\/jats:sec>Population<\/jats:title>Women with PPH<\/jats:styled-content> \u22651500\u00a0ml (n<\/jats:italic>\u00a0=\u00a0233).<\/jats:p><\/jats:sec>Methods<\/jats:title>Systolic blood pressure (BP<\/jats:styled-content>), diastolic BP<\/jats:styled-content>, mean arterial pressure, pulse pressure, heart rate (HR<\/jats:styled-content>) and SI<\/jats:styled-content> (HR<\/jats:styled-content>\/systolic\u00a0BP<\/jats:styled-content>) were measured within the first hour following PPH<\/jats:styled-content>. Values measured at the time of highest SI<\/jats:styled-content> were selected for analysis. The area under the receiver operating characteristic curve (AUROC<\/jats:styled-content>) for each parameter, used to predict admission to an intensive care unit and other adverse outcomes, was calculated. Sensitivity, specificity and negative\/positive predictive values determined thresholds of the best predictor.<\/jats:p><\/jats:sec>Main outcome measures<\/jats:title>Intensive care unit (ICU) admission, blood transfusion\u00a0\u22654\u00a0iu, haemoglobin level\u00a0<7\u00a0g\/dl, and invasive surgical procedures.<\/jats:p><\/jats:sec>Results<\/jats:title>Shock index has the highest AUROC<\/jats:styled-content> to predict ICU<\/jats:styled-content> admissions (0.75 for SI<\/jats:styled-content> [95%\u00a0CI<\/jats:styled-content> 0.63\u20130.87] compared with 0.64 [95%\u00a0CI<\/jats:styled-content> 0.44\u20130.83] for systolic\u00a0BP<\/jats:styled-content>). SI<\/jats:styled-content> compared favourably for other outcomes: SI<\/jats:styled-content>\u00a0\u22650.9 had 100% sensitivity (95%\u00a0CI<\/jats:styled-content> 73.5\u2013100) and 43.4% specificity (95%\u00a0CI<\/jats:styled-content> 36.8\u201350.3), and SI<\/jats:styled-content>\u00a0\u22651.7 had 25.0% sensitivity (95%\u00a0CI<\/jats:styled-content> 5.5\u201357.2) and 97.7% specificity (CI<\/jats:styled-content>\u00a094.8\u201399.3), for predicting ICU<\/jats:styled-content> admission.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>Shock index compared favourably with conventional vital signs in predicting ICU<\/jats:styled-content> admission and other outcomes in PPH<\/jats:styled-content>, even after adjusting for confounding; SI<\/jats:styled-content>\u00a0<0.9 provides reassurance, whereas SI<\/jats:styled-content>\u00a0\u22651.7 indicates a need for urgent attention. In low\u2010resource settings this simple parameter could improve outcomes. It was not possible to adjust for resuscitative measures administered following vital sign measurement that may have influenced the outcome.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.13206","type":"journal-article","created":{"date-parts":[[2014,12,26]],"date-time":"2014-12-26T06:46:52Z","timestamp":1419576412000},"page":"268-275","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":134,"title":["Shock index: an effective predictor of outcome in postpartum haemorrhage?"],"prefix":"10.1111","volume":"122","author":[{"given":"HL","family":"Nathan","sequence":"first","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"El Ayadi","sequence":"additional","affiliation":[{"name":"Safe Motherhood Programs University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"NL","family":"Hezelgrave","sequence":"additional","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Seed","sequence":"additional","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E","family":"Butrick","sequence":"additional","affiliation":[{"name":"Safe Motherhood Programs University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Miller","sequence":"additional","affiliation":[{"name":"Safe Motherhood Programs University of California San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Briley","sequence":"additional","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Bewley","sequence":"additional","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"AH","family":"Shennan","sequence":"additional","affiliation":[{"name":"Women's Health Academic Centre King's College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,12,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(14)70227-X"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1596\/978-0-8213-6133-7"},{"issue":"1","key":"e_1_2_6_4_1","first-page":"1","article-title":"Saving Mothers\u2019 Lives: reviewing maternal deaths to make motherhood safer: 2006\u20132008. 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