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Original Research

Open Access

New index to predict the possibility of hemostatic angiographic embolization in trauma patients assessed by emergency medical services

  • Ki Hong Kim1
  • Joo Jeong2,*,
  • Kyoung Jun Song3
  • Sang Do Shin1
  • Young Sun Ro1
  • Wen-Chu Chiang4
  • Sabariah Faizah Jamaluddin5
  • Nurul Azlean Norzan6

1Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 03080 Seoul, Republic of Korea

2Department of Emergency Medicine, Seoul National University Bundang Hospital, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 13620 Seoul, Republic of Korea

3Department of Emergency Medicine, Seoul National University Boramae Medical Center, Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 07061 Seoul, Republic of Korea

4Department of Emergency Medicine, National Taiwan University Hospital, Department of Emergency Medicine, National Taiwan University Hospital Yun-Lin Branch, 640203 Douliu, Taiwan

5Department of Emergency Medicine, Universiti Teknologi MARA, 40450 Sungai Buloh, Selangor, Malaysia

6Department of Emergency Medicine, Sungai Buloh Hospital, 47000 Sungai Buloh, Selangor, Malaysia

DOI: 10.22514/sv.2023.056 Vol.19,Issue 4,July 2023 pp.135-143

Submitted: 23 May 2022 Accepted: 11 August 2022

Published: 08 July 2023

*Corresponding Author(s): Joo Jeong E-mail:


Trauma is an important public health issue and a leading cause of mortality worldwide. We developed a concise index that predicts the possibility of hemostatic angiographic embolization in trauma patients assessed by emergency medical services (EMS). Two Asia-Pacific countries were involved in this study: 13 emergency departments (EDs) in South Korea and 15 EDs in Malaysia. Patients with trauma transported by EMS between January 2015 and December 2018 were enrolled in this study. Hemostatic angiographic embolization was defined as the presence of at least one procedure performed within 24 h of the ED visit. A simple index was developed with key components after principal component analysis: scene shock index (SI) + ED SI-prehospital alertness. Prediction performance was evaluated by the area under the receiver operating characteristic curve (AUC) and was compared to the revised trauma score (RTS), age-adjusted shock index (AGE-SI), and surgical intervention in victims of motor vehicle crashes (SIM) score. A total of 28,772 patients were included in the final analysis. Overall, 657 patients (2.3%) underwent hemostatic angiographic embolization. Scene SI and ED SI were significantly different: median (q1–q3) was 0.63 (0.75–1.00), 0.69 (0.59–0.85) in patients who underwent hemostatic angiographic embolization and 0.55 (0.64–0.73), 0.61 (0.51–0.72) in patients who did not undergo hemostatic angiographic embolization. Prehospital alertness was observed in 192 (29.2%) and 19,978 (71.1%) patients with and without hemostatic angiographic embolization, respectively. Greater predictive performance for hemostatic angiographic embolization was observed (AUC: 0.792 for new index, 0.672 for SIM score, 0.562 for RTS, and 0.507 for AGE-SI). A new index showed higher predictive performance for hemostatic angiographic embolization in adult EMS-transported trauma patients compared to the SIM score, RTS, and AGE-SI.


Trauma; Emergency medical services; Therapeutic embolization; Clinical decision support

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Ki Hong Kim,Joo Jeong,Kyoung Jun Song,Sang Do Shin,Young Sun Ro,Wen-Chu Chiang,Sabariah Faizah Jamaluddin,Nurul Azlean Norzan. New index to predict the possibility of hemostatic angiographic embolization in trauma patients assessed by emergency medical services. Signa Vitae. 2023. 19(4);135-143.


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