The utility of base deficit and arterial lactate in differentiating major from minor injury in trauma patients with normal vital signs.
OBJECTIVE
Early recognition and treatment of hemorrhagic shock after trauma limits multi-organ failure and mortality. Traditional vital signs (VS) although specific are not highly sensitive for hemorrhage detection. Metabolic parameters such as lactate and base deficit (BD) are highly sensitive indicators of blood loss by measuring tissue perfusion. Does adding information from BD and lactate to traditional VS improve the identification of trauma patients with major injuries?


METHODS
We conducted a retrospective study of a prospectively collected database at a Level I trauma center from January 2003 to September 2005. Patients >13 years, suspected of having significant injury by mechanism, were included. Abnormal VS were defined by heart rate >100 beats/min or systolic blood pressure <90 mmHg. Metabolic parameters from initial arterial blood gas were measured in all patients, abnormal defined by BD >-2.0 mMol/L or lactate >2.2 mMol/L. Our outcome variable, major injury, was defined as any trauma patient who received a blood transfusion, or dropped their hematocrit >10 points in the first 24 h, or had an Injury Severity Score (ISS) >15.


RESULTS
1435 patients were enrolled, 242 (17%) had major injuries. Abnormal VS alone had a sensitivity of 40.9% (95% CI, 34.7-47.1%) for identifying major injury patients. When abnormal metabolic parameters were added, major injury detection increased significantly to a sensitivity of 76.4% (95% CI, 71.1-81.8%).


CONCLUSIONS
The addition of BD and lactate to triage vital signs increases the ability to distinguish major from minor injury.
Paladino
Lorenzo
L
Department of Emergency Medicine, State University of New York Downstate Medical Center, Box 1228, 450 Clarkson Avenue, Brooklyn, NY 11203, United States. LorenzoPaladino@yahoo.com
Sinert
Richard
R
Wallace
David
D
Anderson
Todd
T
Yadav
Kabir
K
Zehtabchi
Shahriar
S
D000137:Acid-Base Imbalance / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001639:Bicarbonates / Q000097:blood*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012771:Shock, Hemorrhagic / Q000097:blood*; D055815:Young Adult
D001639:Bicarbonates; D019344:Lactic Acid