Barnes R, et al. – Authors perform this audit using data from a prospectively entered electronic trauma registry to compare the ability of vital sign based combined shock scores (CSS) to predict in–hospital mortality, need for surgery, need for blood transfusion and ICU admission in trauma patients with shock. The currently available vital sign based scores (Systolic Blood Pressure [SBP], Mean Arterial Pressure [MAP], Shock Index [SI], Modified Shock Index [MSI] and Shock Index multiplied by Age [SIA]) used in the prediction of shock severity and triage seem not good predictors of mortality, need for ICU, need for theatre or need for blood transfusion in this population where half the trauma is penetrating and there are long pre–hospital delays. Findings suggest that none of the proposed CSS's are capable of reliably and accurately identifying and categorizing shock states in South African trauma patients.