title: A critical reappraisal of the ATLS classification of hypovolaemic shock: does it really reflect clinical reality?
abstract: OBJECTIVE
  The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS).
  
  
  METHODS
  Patients derived from the TraumaRegister DGU(®) database between 2002 and 2010 were analyzed. First, patients were allocated into the four classes of hypovolaemic shock by matching the combination of heart rate (HR), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) according to ATLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to the ATLS classification and the corresponding changes of the remaining two parameters were assessed within these four groups. Analyses of demographic, injury and therapy characteristics were performed as well.
  
  
  RESULTS
  36,504 patients were identified for further analysis. Only 3411 patients (9.3%) could be adequately classified according to ATLS, whereas 33,093 did not match the combination of all three criteria given by ATLS. When patients were grouped by HR, there was only a slight reduction of SBP associated with tachycardia. The median GCS declined from 12 to 3. When grouped by SBP, GCS dropped from 13 to 3 while there was no relevant tachycardia observed in any group. Patients with a GCS=15 presented normotensive and with a HR of 88/min, whereas patients with a GCS<12 showed a slight reduced SBP of 117mmHg and HR was unaltered.
  
  
  CONCLUSIONS
  This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately.
authors: Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, Cologne, Germany. manuelmutschler@web.de
authors: M
authors: M
authors: Mutschler
authors: U
authors: U
authors: Nienaber
authors: T
authors: T
authors: Brockamp
authors: A
authors: A
authors: Wafaisade
authors: H
authors: H
authors: Wyen
authors: S
authors: S
authors: Peiniger
authors: T
authors: T
authors: Paffrath
authors: B
authors: B
authors: Bouillon
authors: M
authors: M
authors: Maegele
mesh_terms: D000328:Adult; D061906:Advanced Trauma Life Support Care / Q000145:classification*; D005060:Europe; D005260:Female; D015600:Glasgow Coma Scale; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D015203:Reproducibility of Results; D012769:Shock / Q000145:classification* / Q000209:etiology / Q000503:physiopathology; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology