1.Value of Shock Index in Prognosticating The Short Term Outcome of Death for Patients Presenting With Severe Sepsis and Septic Shock in The Emergency Department
Shah Jahan Mohd Yussof ; Mohd Idzwan Zakaria ; Fatahul Laham Mohamed ; Mohamad Adam Bujang ; Sharmila Lakshmanan ; Abu Hassan Asaari
The Medical Journal of Malaysia 2012;67(4):406-411
Introduction: The importance of early recognition and
treatment of sepsis and its effects on short-term survival
outcome have long been recognized. Having reliable
indicators and markers that would help prognosticate the
survival of these patients is invaluable and would
subsequently assist in the course of effective dynamic
triaging and goal directed management.
Study Objectives: To determine the prognosticative value of
Shock Index (SI), taken upon arrival to the emergency
department and after 2 hours of resuscitation on the shortterm outcome of severe sepsis and septic shock patients.
Methodology: This is a retrospective observational study
involving 50 patients admitted to the University of Malaya
Medical Centre between June 2009 and June 2010 who have
been diagnosed with either severe sepsis or septic shock.
Patients were identified retrospectively from the details
recorded in the registration book of the resuscitation room. 50 patients were selected for this pilot study. The population comprised 19 males (38%) and 31 females (62%). The median (min, max) age was 54.5 (17.0, 84.0) years. The
number of severe sepsis and septic shock cases were 31
(62%), and 19 (38%) respectively. There were 17 (34%) cases
of pneumonias, 13 (26%) cases of urological sepsis, 8 (16%)
cases of gastro intestinal tract related infections and 12
(24%) cases of other infections. There were a total of 23
(46%) survivors and 27 (54%) deaths. The value of the shock
index is defined as systolic blood pressure divided by heart rate was calculated. Shock Index on presentation to ED (SI 1) and after 2 hours of resuscitation in the ED (SI 2). The median, minimum and maximum variables were tested using Mann-Whitney U and Chi square analysis. The significant parameters were re-evaluated for sensitivity, specificity and cut-off points. ROC curves and AUC values were generated among these variables to assess prognostic utility for outcome.
Results: Amongst all 7 variables tested, 2 were tested to be significant (p: < 0.05). From the sensitivity, specificity and ROC analysis, the best predictor for death was (SI 2) with a sensitivity of 80.8%, specificity of 79.2%, AUC value of 0.8894 [CI95 0.8052, 0.9736] at a cut-off point of ≥1.0.
Conclusion: (SI 2) may potentially be utilized as a reliable predictor for death in patients presenting with septic shock and severe sepsis in an emergency department. This parameters should be further analyzed in a larger scale prospective study to determine its validity.
2.Administration of tranexamic acid for victims of severe trauma within pre-hospital care ambulance services (PHCAS) in Malaysia
Shah Jahan Mohd Yussof ; Shamila Mohamad Ali ; Nurul Azlean Norzan ; Mohd Amin Mohidin ; Anandakumar Krishnan ; Ahmad Ibrahim Kamal Batcha ; Ahmad Tajuddin Mohamad Nor ; Aik Howe Teo ; Mohamed Saed Mian ; Fatahul Laham Mohamed ; Ridzuan Mohd Isa ; Mohd Idzwan Zakaria ; Mohd Khairizam Mohd Yusoff ; Joseph Mathew ; Mark Fitzgerald ; Sabariah Faizah Jamaluddin ; Kiat Kee Gan
The Medical Journal of Malaysia 2019;74(4):300-306
Introduction: Trauma is a Global threat and the 5th highest
cause of all-cause mortality in Malaysia caused
predominantly due to road traffic accidents. Majority of
trauma victims are young adults aged between 21-40 years
old. In Malaysia, 24 out of 100,000 population die annually
due to trauma, rating us amongst the highest in South East
Asia. These alarming figures justify aggressive preventive
and mitigation strategies. The aim of this paper is to
promote the implementation of evidence-based
interventions that will reduce the rate of preventable death
because of trauma. Tranexamic acid is one of the few
interventions in the early management of severe trauma with
level-one evidence. Tranexamic acid has been proven to
reduce all causes of mortality and mortality due to bleeding.
Evidence proves that it is most effective when administered
early, particularly within the 1st hour of trauma. This
proposed guideline is formulated based upon quality
evidence from multicentre studies, clinical practices in other
countries and consideration of the local demographic
factors with the intent of enabling an easy and simple
pathway to administer tranexamic acid early in the care of
the severely injured.
Conclusion: The guideline highlights select pre-hospital
criteria’s and the methods for drug administration. The
authors recognise that some variants may be present
amongst certain institutions necessitating minor
adaptations, nevertheless the core principles of advocating
tranexamic acid early in the course of pre-hospital trauma
should be adhered to.