Promising initial evaluation: the Shock Thyroid Imaging Score (STIS) could predict mortality in hemodynamically unstable trauma patients.

PURPOSE: To evaluate a newly proposed ‘Shock Thyroid Imaging Score’ (STIS) for predicting mortality in hemodynamically unstable trauma patients and to assess association of STIS with the Hypovolemic Shock Complex (HSC). MATERIALS AND

METHODS

This is a retrospective, single-center study of consecutive hemodynamically unstable trauma patients receiving contrast-enhanced CT between January 2016 and September 2018. A STIS was calculated from scored signs of shock thyroid on chest CTs and correlated to well published abdominal CT signs of HSC. Multivariable logistic regression evaluated STIS association with mortality and compared STIS with Glasgow Coma Scale (GCS) and systolic blood pressure (SBP) in predicting mortality.

RESULTS

A total of 748 patients (mean age 47 years ± 22; 554 men) were evaluated. STIS was associated with all abdominal visceral signs of HSC on CT, for example adrenal hyperenhancement in 75% (9/12) for STIS > 3 versus 18% (97/538) for STIS = 0 (P =.001) and with an IVC diameter < 9 mm (58% for STIS > 3 (7/12) versus 17% (93/533) when STIS = 0, P <.001), but not with aortic caliber < 13 mm (0% for STIS > 3 (0/12) versus 2% (13/533) for STIS = 0, P =.180). Multivariable logistic regression modelling demonstrated association of higher STIS with in-hospital mortality (odds ratio (OR), 1.54; P <.001), being a stronger predictor of mortality than lower GCS (OR, 1.19; P <.001) and SBP on arrival (OR, 1.0; P =.006).

CONCLUSION

Initial evaluation of the proposed Shock Thyroid Imaging Score (STIS) suggests that it could predict mortality in hemodynamically unstable trauma patients and may be a better early prognosticator than Glasgow Coma Scale and systolic blood pressure. Further validation is needed.