Are resuscitation and operation justified in injured patients with extreme base deficits (less than -20)?
BACKGROUND
This study assessed the outcome of injured patients in shock with an admission base deficit of -20 or less (approximate pH <7.0) at a level 1 trauma center.


METHODS
A retrospective review was made of the trauma registry, supplemented by chart review, of all trauma patients admitted with a base deficit -20 or less from 1995 to 2002. Data collected included mechanism of injury, base deficit, Injury Severity Score(ISS), operative procedures, and outcome. Data are presented as mean +/- SD.


RESULTS
Over the study period, 110 trauma patients (88% male; 31 +/- 13 years; 34% blunt trauma; ISS 26 +/- 15) were admitted with base deficit of -20 or less. Overall survival was 38%, with the majority of deaths occurring within hours of admission.


CONCLUSIONS
An admission base deficit of -20 or less is associated with high mortality in patients with gunshot wounds (64%) or blunt trauma (70%). The majority of patients who die will do so within hours of admission. Beyond 24 hours, the survival rates of 73% for patients with blunt trauma, 79% for those with gunshot wounds, and 90% for those with stab wounds justify continuing resuscitation and reoperations.
Tremblay
Lorraine N
LN
Department of Surgery, Grady Memorial Hospital, and Emory University School of Medicine, Atlanta, GA 30303, USA.
Feliciano
David V
DV
Rozycki
Grace S
GS
D000137:Acid-Base Imbalance / Q000150:complications*; D000328:Adult; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D006863:Hydrogen-Ion Concentration; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D012151:Resuscitation; D012189:Retrospective Studies; D012774:Shock, Traumatic / Q000097:blood / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000097:blood / Q000401:mortality / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000401:mortality / Q000601:surgery; D014951:Wounds, Stab / Q000097:blood / Q000401:mortality / Q000601:surgery