Shock Index
Ratio of heart rate to systolic blood pressure. Identifies haemodynamically unstable patients and predicts mortality in various emergency conditions including trauma, sepsis, and obstetric emergencies.
Score interpretation
Shock Index < 0.6: Normal haemodynamic status.
→ No immediate haemodynamic intervention required.
Shock Index 0.6–1.0: Normal range. Mild elevation possible in compensated shock.
→ Monitor. Reassess if clinical deterioration.
Shock Index > 1.0: Increased mortality risk. Significant haemodynamic compromise.
→ IV access, fluid challenge, crossmatch. Identify source: haemorrhage, sepsis, PE, cardiogenic.
Shock Index > 1.4: High mortality risk. Consider massive transfusion protocol in trauma.
→ Immediate resuscitation. Activate MTP in trauma. Senior review. ICU referral.
Interpretation bands for the Shock Index. Apply clinical judgement and local guidance.
References
- Allgöwer M, Burri C. Schockindex. Dtsch Med Wochenschr. 1967;92(43):1947–1950.
- Cannon CM, et al. The GENESIS Project (GENeralization of Early Sepsis InterventionS): a multicenter quality improvement collaborative. Acad Emerg Med. 2013;20(6):575–578.
Related
Curated clinical cross-links plus same-class fallbacks.
- Hydrocortisone (ICU — Stress Dosing) · Corticosteroid (ICU/Septic Shock)
- Tranexamic Acid (ICU/Trauma/Surgical) · Antifibrinolytic
- Noradrenaline (Cardiogenic Shock / Vasopressor) · Vasopressor / Cardiogenic Shock
- Vasopressin / Terlipressin · Vasopressin Analogue — Vasodilatory Shock / Variceal Bleeding
- Ceftriaxone (Paediatric) · Third-Generation Cephalosporin — Meningitis / Sepsis / Community-Acquired Pneumonia
- Gentamicin (Paediatric) · Aminoglycoside — Neonatal Sepsis / Gram-Negative Infections in Children
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The Shock Index is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.