Hemoglobin drops within minutes of injuries and predicts need for an intervention to stop hemorrhage.
BACKGROUND
Hemoglobin (Hgb) levels obtained shortly after injury may not detect occult bleeding in trauma patients because of the time needed for plasma levels to equilibrate, or may be confounded by crystalloid-related hemodilution. We hypothesized that Hgb levels measured within minutes of arrival can identify trauma patients who are actively bleeding.


METHODS
A retrospective study of 404 consecutive patients was undertaken at an urban Level I trauma center, which included 39 patients who required emergent surgical or radiologic intervention to control bleeding. All 404 patients underwent point-of-care Hgb measurements within 30 minutes of emergency department (ED) arrival. Hgb levels were correlated with physiologic signs of hemorrhage(blood pressure, heart rate, base deficit, pH, and resuscitation volume), and the need for emergent interventions to stop hemorrhage.


RESULTS
Early Hgb levels were significantly lower in patients who required emergent interventions to stop hemorrhage (mean +/- SD: 12 +/- 2 gm/dL vs. 13 +/- 2 gm/dL, p < 0.001). Lower Hgb levels were associated with increasing heart rate, decreasing blood pressure, decreasing pH, worsening base deficit, and increasing transfusion requirements. Hgb < or =10 gm/dL was associated with a greater than three-fold increase in the need for emergent interventions to stop bleeding (odds ratio 3.14, 95% confidence interval 1.18-8.35, p < 0.03), and correctly identified the need for intervention in 87% of patients.


CONCLUSIONS
Hemorrhage in trauma patients is associated with an early decrease in Hgb level. Hgb < or =10 gm/dL in the first 30 minutes of patient arrival will correctly identify presence or absence of significant bleeding in almost 9 of 10 trauma patients.
Bruns
Brandon
B
Division of Burns, Trauma and Critical Care, Department of Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA.
Lindsey
Mark
M
Rowe
Kinsey
K
Brown
Sandra
S
Minei
Joseph P
JP
Gentilello
Larry M
LM
Shafi
Shahid
S
D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000517:prevention & control; D001803:Blood Transfusion; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000032:analysis*; D006470:Hemorrhage / Q000097:blood* / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014505:Urban Population; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality
D006454:Hemoglobins