Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma.
BACKGROUND
Prolonged occult hypoperfusion or POH (serum lactate >2.4 mmol/L persisting >12 hours from admission) represents a reversible risk factor for adverse outcomes following traumatic injury. We hypothesized that patients at increased risk for POH could be identified at the time of admission.


METHODS
Prospective data from adult trauma admissions between January 1, 1998 and December 31, 2000 were analyzed. Potential risk factors for POH were determined by univariate analysis (p < or =0.10= significant). Significant factors were tested in a logistic regression model (LR) (p < or =0.05= significant). The predictive ability of the LR was tested by receiver operating curve (ROC) analysis (p < or =0.05= significant).


RESULTS
Three hundred seventy-eight patients were analyzed, 129 with POH. Injury Severity Score (ISS), emergency department Glasgow Coma Scale score, hypotension, and the individual Abbreviated Injury Scale score (AIS) for Head (H), Abdominal/Pelvic Viscera (A) and Pelvis/Bony Extremity (P) were significantly associated with POH. LR demonstrated that ISS, A-AIS > or =3 and P-AIS > or =3 were independent predictors of POH (p <0.05). ROC analysis of the LR equation was statistically significant (Area=0.69, p <0.001).


CONCLUSIONS
We identified factors at admission that placed patients at higher risk for developing POH. Select patients may benefit from rapid, aggressive monitoring and resuscitation, possibly preventing POH and its associated morbidity and mortality.
Schulman
Andrew M
AM
Trauma Research Laboratory, University of Virginia Health System, Department of Surgery, Charlottesville, Virginia 22908-0709, USA.
Claridge
Jeffrey A
JA
Carr
Gordon
G
Diesen
Diana L
DL
Young
Jeffrey S
JS
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012151:Resuscitation / Q000379:methods; D018570:Risk Assessment; D017678:Sex Distribution; D012769:Shock / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D015996:Survival Rate; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy