title: Does thoracic injury impair the predictive value of base deficit in trauma patients?
abstract: INTRODUCTION: Base deficit (BD) has been shown to be a valuable indicator to be predictive of complications and mortality after trauma. Arterial carbon dioxide (PaCO(2)) may be influenced by thoracic injuries, potentially diminishing the predictive value of BD. Therefore, the aim of this study was to assess the predictive value of admission BD for mortality and complications in trauma patients with thoracic injuries. METHODS: By a prospective database analysis of patients with an injury to the chest admitted to the University Medical Center Utrecht between 2000 and 2004 were studied. All patients with a blood gas analyses were included. Absolute BD was used for analyses. Clinical outcome parameters were recorded. RESULTS: The BD was higher in the non-surviving patients compared to the survivors (7.5 vs. 3.8, p<0.001). Mortality rate of patients with an admission BD of >/=6 was increased in thoracic trauma patients (BD<6 mortality rate 7%, BD>/=6 mortality rate 27%; p<0.001). In patients who required ICU admittance the BD was increased compared to patients without ICU admission (5.2 vs. 2.9, p<0.001). Within the subgroup of patients admitted to the ICU, the BD was higher in patients who required ventilation (3.8 vs. 5.5, p=0.025). Patients who developed chest related complications had increased BD compared with those without complications (4.9 vs. 4.0, p=0.025), the BD was particularly increased in patients who developed acute respiratory distress syndrome (ARDS) (4.1 vs. 6.4, p=0.004). Carbon dioxide (PaCO(2)) showed a predictive value for mortality (44 vs. 53, p<0.001), ICU admission (42 vs. 46, p=0.003) and hospital stay. CONCLUSION: Admission BD is a predictive factor in thoracic trauma patients for mortality and chest related complications. Furthermore it is a predictive factor for ICU admission, required ventilation and hospital stay. The use of BD in thoracic trauma patients can potentially identify patients who require additional monitoring or early aggressive therapy.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Tjeerd S
authors.initials: TS
authors.lastname: Aukema
authors.forename: Falco
authors.initials: F
authors.lastname: Hietbrink
authors.forename: Ludo F M
authors.initials: LF
authors.lastname: Beenen
authors.forename: Luke P H
authors.initials: LP
authors.lastname: Leenen