Prospective observational cohort to predict accuracy of Peripheral Perfusion Index, Respiratory Adjusted Shock Index and Reverse Shock Index in predicting Occult Hypoperfusion in Trauma patients

Primary Objective

To evaluate the predictive accuracy of the Peripheral Perfusion Index (PPI), Respiratory Adjusted Shock Index (RASI), and Reverse Shock Index (RSI) for identifying occult hypoperfusion (defined by a serum lactate level > 2 mmol/L or a base deficit <-2 mEq/L) in trauma patients upon arrival at the casualty.

Secondary Objectives

1.To compare the predictive performance of each index (PPI, RASI, and RSI) against the traditional Shock Index (SI) in detecting occult hypoperfusion.

2.To determine the optimal cut-off values for PPI, RASI, and RSI that best predict occult hypoperfusion and adverse clinical outcomes (e.g., need for massive transfusion, ICU admission, mechanical ventilation, or mortality).

PLACE OF STUDY:

This study will be conducted in Ganga Medical Center and Hospital, Coimbatore Level I trauma centre which manages a high volume of severely injured patients

Methodology:

Upon arrival at the trauma bay, the following data would be collected:

Standard vital signs (heart rate, systolic blood pressure, respiratory rate).

Clinical indices (PPI, RASI, and RSI) would be calculated or measured.

Injury characteristics and mechanism of injury.(ISS, RTS)

Simultaneously, point of care lactate levels will be measured by drawing a blood sample within 15-20 minutes of arrival to Trauma Bay

Measurements will be taken pre and post operatively .

Outcomes would be recorded post operatively will also include:

1.Need for massive transfusion protocol activation pre/intra/post operatively

2.Length of stay in the Intensive Care Unit (ICU) and hospital.?

3.Incidence of complications (e.g., acute kidney injury, acute respiratory distress syndrome).

4.Mortality.

5.Post op lactate values indices