Supplementary Material for: Comparison of the Previous and Current Trauma-Related Shock Classifications: A Retrospective Cohort Study from a Level I Trauma Center

Purpose: The aim was to examine the predictive value of the hypovolemic shock classification currently accepted by the Advanced Trauma Life Support (ATLS) program over the previous one, which used only vital signs (VS) for patient allocation. The primary outcome was 30-day mortality; as secondary outcome, heart rate (HR), systolic blood pressure (SBP), Glasgow Coma Scale (GCS) and base deficit (BD) data were compared and investigated in terms of mortality prediction. Methods: Retrospective analysis at a level I trauma center between 2014 and 2019. Adult patients treated by trauma teams were allocated into severity classes (I–IV) based on the criteria of the current and previous ATLS classifications, respectively. The prognostic values for the classifications were determined with Fisher’s exact test and χ2 test for independence, and compared with the 2-proportion Z test. The individual variables were analyzed with receiver-operating characteristic (ROC) analyses. Results: A total of 156 patients met the inclusion criteria. Mortality was effectively predicted by both classifications, and there was no statistically significant difference between the predictive performances. According to ROC analyses, GCS, BD and SBP had significant prognostic values while HR change was ineffective in this regard. Conclusions: The currently used ATLS shock classification does not appear to be superior to the VS-based previous classification. GCS, BD and SBP are useful parameters to predict the prognosis. Changes in HR do not reflect the clinical course accurately; thus, further studies will be needed to determine the value of this parameter in trauma-associated hypovolemic-hemorrhagic shock conditions.

研究目的：旨在对比当前被高级创伤生命支持（Advanced Trauma Life Support, ATLS）方案所采用的低血容量性休克分级，与既往仅以生命体征（vital signs, VS）划分患者类别的分级体系的预测价值。主要结局指标为30天死亡率；次要结局指标则对比分析了心率（heart rate, HR）、收缩压（systolic blood pressure, SBP）、格拉斯哥昏迷量表（Glasgow Coma Scale, GCS）及碱缺失（base deficit, BD）数据在死亡率预测方面的表现。

研究方法：于2014至2019年间在一家一级创伤中心开展回顾性分析。将创伤团队救治的成年患者分别依据当前及既往ATLS分级标准划分为严重程度分级（I~IV级）。采用Fisher确切概率法与卡方独立性检验评估两种分级体系的预后价值，并通过两比例Z检验进行对比；针对单个变量则采用受试者工作特征（receiver-operating characteristic, ROC）分析。

研究结果：共计156例患者符合纳入标准。两种分级体系均能有效预测患者死亡率，且二者的预测性能无统计学显著差异。ROC分析结果显示，GCS、BD及SBP具有显著的预后价值，而HR变化则无相关预测价值。

研究结论：当前使用的ATLS休克分级并不优于既往基于生命体征的分级体系。GCS、BD及SBP是有效的预后预测参数。HR变化无法准确反映临床病程，因此需开展进一步研究以明确该参数在创伤相关低血容量出血性休克情境中的应用价值。