{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:14:30Z","timestamp":1785413670018,"version":"3.56.0"},"reference-count":21,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100011576","name":"\u0130n\u00f6n\u00fc University Scientific Research Projects Unit","doi-asserted-by":"publisher","award":["TSA-2026-4942"],"award-info":[{"award-number":["TSA-2026-4942"]}],"id":[{"id":"10.13039\/501100011576","id-type":"DOI","asserted-by":"publisher"}]},{"award":["TSA-2026-4942"],"award-info":[{"award-number":["TSA-2026-4942"]}],"id":[{"id":"https:\/\/ror.org\/04asck240","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Early mortality risk stratification after CT-confirmed cervical spine fractures remains clinically challenging in patients with major trauma. Imaging establishes a structural diagnosis, but it does not fully capture early physiological deterioration. This study aimed to develop and internally validate a prognostic model for in-hospital mortality and evaluate whether a MAP-derived Shock Index provides incremental prognostic information beyond routinely available clinical variables and the Injury Severity Score (ISS). Methods: This retrospective single-center cohort study included 131 adults with CT-confirmed cervical spine fractures and ISS \u2265 15 who were admitted to a tertiary trauma center between 2013 and 2023. The MAP-derived Shock Index was calculated as heart rate divided by estimated systolic blood pressure, where estimated systolic blood pressure was defined a priori as 1.5 \u00d7 MAP. Four prespecified logistic regression models were evaluated: a base clinical model, base plus MAP-derived Shock Index, base plus ISS, and base plus MAP-derived Shock Index plus ISS. Discrimination, Brier score, calibration, bootstrap internal validation, and decision curve analyses were performed. Results: The in-hospital mortality rate was 22.9% (30\/131). The base plus MAP-derived Shock Index model achieved an apparent AUC of 0.93 and an optimism-corrected AUC of 0.91. The MAP-derived Shock Index provided incremental prognostic information beyond the ISS; as an individual predictor, its AUC was 0.82 compared with 0.74 for the ISS. With each 0.1-unit increase, the MAP-derived Shock Index was associated with higher odds of in-hospital mortality. Decision curve analysis suggested a higher apparent net benefit across clinically relevant thresholds. Conclusions: In this internally validated retrospective cohort, the MAP-derived Shock Index complemented clinical and ISS-based assessments for early in-hospital mortality risk stratification after CT-confirmed cervical spine fracture. The index is not the conventional SBP-based Shock Index, and the model requires external multicenter validation before clinical use.<\/jats:p>","DOI":"10.3390\/diagnostics16142272","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:14:27Z","timestamp":1784621667000},"page":"2272","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["MAP-Derived Shock Index for Point-of-Care Physiological Risk Stratification After CT-Confirmed Cervical Spine Fracture: Development and Internal Validation of a Prognostic Model for In-Hospital Mortality"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5505-6250","authenticated-orcid":false,"given":"Mustafa Safa","family":"Pepele","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melike","family":"Karata\u015f Ayhan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5618-8514","authenticated-orcid":false,"given":"Serdar","family":"Derya","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2996-4549","authenticated-orcid":false,"given":"Mahmut","family":"Murat","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u015e\u00fckr\u00fc","family":"G\u00fcrb\u00fcz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5845-2614","authenticated-orcid":false,"given":"Neslihan","family":"Y\u00fccel","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Faculty of Medicine, \u0130n\u00f6n\u00fc University, Malatya 44280, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1097\/BRS.0b013e3181557b92","article-title":"The Subaxial Cervical Spine Injury Classification System: A novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex","volume":"32","author":"Vaccaro","year":"2007","journal-title":"Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S14","DOI":"10.1097\/BOT.0000000000000947","article-title":"AOSpine Classification Systems (Subaxial, Thoracolumbar)","volume":"31","author":"Schnake","year":"2017","journal-title":"J. Orthop. Trauma"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1055\/s-0033-1356764","article-title":"Subaxial cervical spine trauma: Evaluation and surgical decision-making","volume":"4","author":"Joaquim","year":"2014","journal-title":"Glob. Spine J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1097\/00005373-198704000-00005","article-title":"Evaluating trauma care: The TRISS method. Trauma Score and the Injury Severity Score","volume":"27","author":"Boyd","year":"1987","journal-title":"J. Trauma"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.injury.2016.12.009","article-title":"Mortality prediction models in the general trauma population: A systematic review","volume":"48","author":"Polinder","year":"2017","journal-title":"Injury"},{"key":"ref_6","first-page":"384\u2013388; discussion 388\u2013390","article-title":"Identifying risk for massive transfusion in the relatively normotensive patient: Utility of the prehospital shock index","volume":"70","author":"Vandromme","year":"2011","journal-title":"J. Trauma"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"179","DOI":"10.2147\/OAEM.S178358","article-title":"Shock index in the emergency department: Utility and limitations","volume":"11","author":"Koch","year":"2019","journal-title":"Open Access Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0196-0644(94)70279-9","article-title":"A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department","volume":"24","author":"Rady","year":"1994","journal-title":"Ann. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/1742-6723.12232","article-title":"Review article: Shock Index for prediction of critical bleeding post-trauma: A systematic review","volume":"26","author":"Olaussen","year":"2014","journal-title":"Emerg. Med. Australas."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2559","DOI":"10.1007\/s00068-022-01932-z","article-title":"Shock index as a predictor for mortality in trauma patients: A systematic review and meta-analysis","volume":"48","author":"Vang","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"19696","DOI":"10.1038\/s41598-022-24272-9","article-title":"Predictive value of shock index variants on 30-day mortality of trauma patients in helicopter emergency medical services: A nationwide observational retrospective multicenter study","volume":"12","author":"Iirola","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"S101","DOI":"10.1097\/00007632-200112151-00017","article-title":"The role and timing of decompression in acute spinal cord injury: What do we know? What should we do?","volume":"26","author":"Fehlings","year":"2001","journal-title":"Spine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1097\/00007632-200112151-00002","article-title":"Epidemiology, demographics, and pathophysiology of acute spinal cord injury","volume":"26","author":"Sekhon","year":"2001","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"The Spinal Trauma Study Group, Anderson, P.A., Moore, T.A., Davis, K.W., Molinari, R.W., Resnick, D.K., Vaccaro, A.R., Bono, C.M., Dimar, J.R., and Aarabi, B. (2007). Cervical spine injury severity score: Assessment of reliability. J. Bone Jt. Surg. Am., 89, 1057\u20131065.","DOI":"10.2106\/JBJS.F.00684"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1179\/204577211X13207446293695","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum","year":"2011","journal-title":"J. Spinal Cord Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/S1474-4422(20)30406-3","article-title":"The influence of timing of surgical decompression for acute spinal cord injury: A pooled analysis of individual patient data","volume":"20","author":"Badhiwala","year":"2021","journal-title":"Lancet Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"R191","DOI":"10.1186\/cc10348","article-title":"Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, Age, and Systolic Blood Pressure score","volume":"15","author":"Kondo","year":"2011","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"55","DOI":"10.7326\/M14-0697","article-title":"Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): The TRIPOD Statement","volume":"162","author":"Collins","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"i6","DOI":"10.1136\/bmj.i6","article-title":"Net benefit approaches to the evaluation of prediction models, molecular markers, and diagnostic tests","volume":"352","author":"Vickers","year":"2016","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2534","DOI":"10.1200\/JCO.2015.65.5654","article-title":"Assessing the clinical impact of risk prediction models with decision curves: Guidance for correct interpretation and appropriate use","volume":"34","author":"Kerr","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kuo, K.-M., and Chang, C.S. (2025). A meta-analysis of the diagnostic test accuracy of artificial intelligence in predicting emergency department dispositions (admission, critical care, and mortality). BMC Med. Inform. Decis. Mak., 25.","DOI":"10.1186\/s12911-025-03010-x"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2272\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T08:35:58Z","timestamp":1784622958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/14\/2272"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":21,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["diagnostics16142272"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16142272","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}