• LeeHyoung YounHYDepartment of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: apostle09@naver.com., Sung Min Lee, Kyung Woon Jeung, Byung Kook Lee, Jun Ho Han, Tag Heo, and Yong Il Min.
• Department of Emergency Medicine, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju, Republic of Korea. Electronic address: apostle09@naver.com.
• Injury. 2021 May 1; 52 (5): 1151-1157.

IntroductionThis study aimed to investigate the ion shift index (ISI) as a prognostic factor of severe trauma. We hypothesized that the initial ISI measured in the emergency department (ED) is associated with discharge survival in severe non-isolated head injury (IHI) patients.Materials And MethodsThis retrospective observational study included severe trauma patients with available medical records from January 2017 to December 2018 but excluded those with IHI. Logistic regression analysis was conducted to identify the risk factors for mortality in non-IHI patients, and adjustments were performed for relevant covariates. An area under the receiver operating characteristics curve (AUROC) analysis was performed to examine the primary outcome of our study, which was mortality at hospital discharge in severe non-IHI trauma patients.ResultsOf the 483 severe non-IHI trauma patients included in the study, 86 patients (17.8 %) died. The multiple logistic regression analysis demonstrated ISI (odds ratio [OR], 2.300; 95% CI, 1.183-4.470) was significantly associated with mortality in the non-IHI group. Additionally, trauma and injury severity score (TRISS; OR, 0.538; 95% CI, 0.447-0.649), lactate (OR, 1.410; 95% CI, 1.252-1.588), creatinine (OR, 1.554; 95% CI, 1.221-1.979), and activated partial thromboplastin time (aPTT; OR, 1.050; 95% CI, 1.021-1.080) were independently associated with mortality at hospital discharge. The AUROC values for TRISS, lactate, aPTT, creatinine, and ISI were as follows: 0.892 (95% CI, 0.861-0.918), 0.838 (95% CI, 0.803-0.870), 0.754 (95% CI, 0.712-0.792), 0.650 (95% CI, 0.606-0.693), and 0.848 (95% CI, 0.813-0.879), respectively. The AUROC for the multiple logistic regression model with ISI was 0.942 (95% CI, 0.917-0.962). In a model in which TRISS was omitted, the addition of ISI to other predictors significantly improved the AUROC to 0.900 (95% CI, 0.869-0.925) (p=0.039).ConclusionThe initial ISI in the ED after trauma was associated with mortality in severe non-IHI trauma patients. In conjunction with other prognostic indicators, it could be used as an early prognostic marker, particularly if TRISS is unavailable.Copyright © 2021. Published by Elsevier Ltd.

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