Using Vital Signs to Place Acutely Ill Patients Quickly and Easily into Clinically Helpful Pathophysiologic Categories: Derivation and Validation of Eight Pathophysiologic Categories in Two Distinct Patient Populations of Acutely Ill

Background: Early warning scores reliably identify patients at risk of imminent death, but do not provide insight into what may be wrong with the patient or what to do about it. Objective: Our aim was to explore whether the Shock Index (SI), pulse pressure (PP), and ROX Index can place acutely ill medical patients in pathophysiologic categories that could indicate the interventions required. Methods: A retrospective post-hoc analysis of previously obtained and reported clinical data for 45,784 acutely ill medical patients admitted to a major regional referral Canadian hospital between 2005 and 2010 and validated on 107,546 emergency admissions to four Dutch hospitals between 2017 and 2022. Results: SI, PP, and ROX values divided patients into eight mutually exclusive physiologic categories. Mortality was highest in patient categories that included ROX Index value < 22, and a ROX Index value < 22 multiplied the risk of any other abnormality. Patients with a ROX Index value < 22, PP < 42 mm Hg, and SI > 0.7 had the highest mortality and accounted for 40% of deaths within 24 h of admission, whereas patients with a PP > 42 mm Hg, SI < 0.7, and ROX Index value > 22 had the lowest risk of death. These results were the same in both the Canadian and Dutch patient cohorts. Conclusions: SI, PP, and ROX Index values can place acutely ill medical patients into eight mutually exclusive patho

Automated summary

The study aims to explore whether the Shock Index (SI), pulse pressure (PP), and ROX Index can categorize acutely ill medical patients into pathophysiological groups to guide interventions. After retrospective analysis of data from 45,784 acutely ill patients, it was found that SI, PP, and ROX values divided patients into eight mutually exclusive physiological categories. Patients with a ROX Index value < 22 had the highest mortality, and a ROX Index value < 22 multiplied the risk of any other abnormality. The score for this study is: 9/10.