Papers presentedSystemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample
Section snippets
Methods
The National Trauma Data Bank (NTDB) of the American College of Surgeons, the largest nationwide database of trauma patients, with more than 400 participating trauma centers and more than 1 million individual records, was queried (NTDB, version 4.0, 2004; N = 1,130,581). We used base deficit in the emergency department as a marker of shock because it has been validated previously as a reliable marker of shock severity in injured patients [11], [14], [15], [16]. Base deficit was measured in a
Results
In the study population, 64% of patients were 15 to 44 years of age, 71% were male, 82% sustained a blunt injury, and 74% were treated at a level 1 trauma center. The mean GCS was 12 ± 5, the Injury Severity Score was 16 ± 13, and the base deficit was −2 ± 5. The overall mortality rate was 10%, with a mean length of stay of 9 ± 15 days. Systemic hypotension was noted in 7,910 patients (7%). Compared with patients with a higher SBP, hypotensive patients had a significantly higher mortality rate
Comments
This study shows that systemic hypotension in trauma patients does not occur until the degree of shock is profound, and, hence, is an unreliable means of detecting clinically significant shock. This study validates the long-standing ATLS principle that hypotension is a late marker of shock in a large national sample of trauma patients. Although the relationship between systemic hypotension and outcome is well documented, few studies have shown the magnitude of shock and degree of anaerobic
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