Evaluation of the shock index in dogs presenting as emergencies

Authors

  • Adam E. Porter DVM, DACVECC,

    1. Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
    Current affiliation:
    1. Katonah Bedford Veterinary Center, Bedford Hills, NY 01507
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  • Elizabeth A. Rozanski DVM, DACVIM, DACVECC,

    Corresponding author
    • Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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  • Claire R. Sharp BVMS, MS, DACVECC,

    1. Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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  • Kursten L. Dixon BS, CVT,

    1. Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
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  • Lori Lyn Price MAS,

    1. Biostatistics Research Center, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University, North Grafton, MA
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  • Scott P. Shaw DVM, DACVECC

    1. Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
    Current affiliation:
    1. New England Veterinary Center and Cancer Care, Windsor, CT 06095
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  • Previously presented in abstract form at the 2010 ACVIM Forum, Anaheim, CA.

  • Support provided by the Short Term Training Grant in Health Professional Schools, supported by NIH T35 DK07635.

Address correspondence and reprint requests to Dr. Elizabeth Rozanski, Cummings School of Veterinary Medicine, Tufts University, 200 Westboro Rd., North Grafton, MA 01536. Email: elizabeth.rozanski@tufts.edu

Abstract

Objectives

To (1) determine a reference interval for shock index (SI) [defined as heart rate (HR)/systolic blood pressure (SBP)], in a group of healthy dogs, and (2) compare SI in healthy dogs with dogs presenting to the emergency room (ER) deemed to be in or not in a state of shock.

Design

Prospective study.

Animals

Sixty-eight clinically normal dogs, 18 dogs that were presented to the ER deemed to be in shock and 19 dogs presenting to the ER not deemed to be in shock.

Setting

University teaching hospital.

Interventions

Peripheral or central venous blood sampling.

Measurements and Main Results

Heart rate and SBP were recorded on simulated presentation (healthy dogs), and emergency presentations for both dogs deemed to be in shock and dogs not deemed in shock. Dogs in shock had a median SI of 1.37 (0.87–3.13), which was significantly higher than both other groups; dogs not deemed in shock had median SI 0.73 (0.56–1.20), P < 0.0001 and healthy dogs had median SI 0.78 (0.37–1.30) P < 0.0001), respectively. Receiver operator characteristic curve analysis suggested a SI cut-off of 1.0, yielding an area under the receiver operator characteristic (AUROC) of 0.89 (Specificity (Sp) 89, Sensitivity (Sn) 90) when comparing dogs deemed in shock with healthy dogs, and 0.92 (Sp 95, Sn 89) when comparing dogs in shock with to dogs not deemed in shock.

Conclusions

The SI is an easy and noninvasive patient parameter that is higher in dogs that are deemed to be in shock than both healthy dogs and dogs presented as emergencies but not deemed to be in a state of shock. The measurement of SI may have some benefit in clinical assessment of emergency patients.

Ancillary