Evaluating trauma burden and predictive value of reverse shock index Glasgow Coma scale (rSIG) in need for early transfusion and mortality: The largest prospective study from India

Objective: Trauma remains a leading cause of death and disability worldwide, with hemorrhage and traumatic brain injury being major contributors. The reverse shock index (SI) multiplied by Glasgow Coma scale (rSIG) is a novel scoring tool with potential for early identification of high-risk trauma patients. This study, the largest and first of its kind in India, aimed to assess the predictive value of rSIG for in-hospital mortality and early transfusion requirements in trauma patients. Material and Methods: This was a prospective, hospital-based study conducted at Government Medical College, Kozhikode, Kerala, from December 2022 to December 2023. A total of 536 trauma patients admitted under the department of general surgery were enrolled. Data on demographics, mechanism of injury, vital signs, GCS score, transfusion requirements, and outcomes were collected. rSIG, SI, and revised trauma score (RTS) were calculated. Receiver operating characteristic analysis was used to assess predictive performance. Results: A total of 536 trauma patients were analyzed (mean age 44.49±15.81 years; 80% males), with road traffic accidents (RTAs) accounting for 68% of cases. RTAs were significantly linked to head and multisystem injuries and contributed to 94% of deaths. Overall mortality was 11.9% (64 patients), exclusively among those with head injury. RTS showed marginally better mortality prediction than rSIG [area under the curve (AUC) 96% vs. 92%; p<0.001], while rSIG best predicted early transfusion need (AUC 91.8%; p<0.01). Conclusion: This study demonstrates that RTAs are the predominant cause of trauma, with head injury as the principal determinant of mortality. While rSIG effectively predicted early transfusion requirements, RTS showed slightly higher accuracy than rSIG in predicting mortality. rSIG remains a practical and reliable triage tool in resource-limited settings.