A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting

Dunham, Mark; Sartorius, Benn; Laing, G L; Bruce, John; Clarke, Damian

doi:10.1016/j.injury.2017.06.011

Cited by 25 publications

(21 citation statements)

References 48 publications

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“…Nevertheless, the early identification of the patient's capacity is challenging, and current methods of identifying insufficient capacity are limited. A study involving 16 000 patients with hypovolemic shock showed that the ability to identify early shock based on the BE value classification was better than that of the current Advanced Trauma Life Support classification of hypovolemic shock (combining heart rate, systolic blood pressure, and Glasgow Coma Scale score) 13 . Furthermore, BE can be used to identify patients who need early blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

Association between base excess and mortality in patients with congestive heart failure

et al. 2020

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Aims The relationship between baseline base excess (BE) and survival outcomes in patients with congestive heart failure (CHF) is unclear. Therefore, we aimed to investigate this relationship based on the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database (v1.4). Methods and results This retrospective cohort study included 5956 adult patients with CHF from the MIMIC-III database from 2001 to 2012. Using the Cox proportional-hazard analysis and Kaplan-Meier plot, we evaluated the relationship between baseline BE and all-cause death at 1 year after admission to the intensive care unit. At the 1 year follow-up, 2104 participants (35.3%) had died. There was an association between BE and all-cause death (log-rank test P < 0.0001). In the Cox regression model adjusted for demographic and clinical variables, the risk of all-cause death in the first (BE ≤ À8), second (À8 < BE ≤ À3), fourth (2 < BE ≤ 7), and fifth (BE > 7) BE groups was significantly higher than that in the third BE group (À3 < BE ≤ 2) [hazard ratio (

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Section: Discussionmentioning

confidence: 99%

Association between base excess and mortality in patients with congestive heart failure

et al. 2020

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“…A number of studies have noted the value of BE as a critical determinant of disease severity (Dunham, Sartorius, Laing, Bruce, & Clarke, 2017; Gale et al, 2016; Shallwani et al, 2015; Soderlund, Ikonen, Pyhalto, & Handolin, 2015). BE can protect against the risk of death to a significantly higher level than other vital signs (Dunham et al, 2017) and may be associated with the risk of potentially fatal coagulation disturbances in patients (Eberhard et al, 2000). Therefore, if acid–base disorders are carefully evaluated in patient, the BE values can inform clinical decision‐making for patients with COPD.…”

Section: Discussionmentioning

confidence: 99%

A protective polymorphism inMMP16, improved blood gas levels, and chronic obstructive pulmonary diseases: Family and two population‐based studies

et al. 2020

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The aberrant expression of matrix metalloproteinases (MMPs) is known to contribute to the pathogenesis of airway remodeling and alveolar disruption in chronic obstructive pulmonary disease (COPD). In the discovery stage, 11 COPD from five families were subjected to whole‐genome sequencing, and 21 common polymorphisms in MMPs and TIMPs were identified. These polymorphisms were genotyped in two subsequent verification studies. Of these polymorphisms, c.2392G>A (rs2664370T>C) and c.4158C>A (rs2664369T>G) in MMP16 remained significantly different. Functionally, we found that MMP16 expression was significantly increased in peripheral blood monocytes (PBMCs) from COPD and in cigarette smoke extract‐treated 16HBE cells compared with controls. This was also shown by bioinformatics analysis. COPD carrying rs2664370CC showed decreased levels of MMP16 in the plasma and in PBMCs compared with those carrying CT and TT. Treatment with hsa‐miR‐576‐5p mimics led to a greater reduction in luciferase reporter activity in cells transfected with rs2664370CC. Moreover, blood levels of base excess, PCO2, and PO2 in COPD with rs2664370CC were significantly lower than those with rs2664370CT+TT. Taken together, these results demonstrate that the rs2664370T>C polymorphism in MMP16 protects against the risk of COPD, likely by favoring interaction with hsa‐miR‐576‐5p, leading to reduced MMP16 expression and improved blood gas levels.

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“…Therefore, participants in our study were allocated based on their worst parameter within the VS and VS+BD criteria. Since the current ATLS classi cation for hypovolaemic shock does not describe exact values for HR, SBP and GCS, we adopted HR values from the previous ATLS classi cation and SBP and GCS values from the study by Dunham et al to make the classi cation criteria objective [19]. (Table 1)…”

Section: Patient Groupsmentioning

confidence: 99%

“…Due to the rapid availability of blood gases, BD is commonly used to assess haemorrhage and its consequences [12] [13] [14]. Several studies have documented its ability to predict outcome in trauma and highlighted its role in patient classi cation [11] [15] [16] [17] [18] [19]. As a consequence, the latest ATLS (ATLS Student Course Manual, 10th edition) recommendation expanded the assessment criteria with the BD value [6].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the previous and current trauma-related shock classifications – The more the better? – A retrospective cohort study from a level I trauma centre

Jávor

Csonka

Butt

et al. 2020

Preprint

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Background: The aim was to compare the predictive performance of the current, extended (VS+BD) Advanced Trauma Life Support (ATLS) classification for hypovolaemic shock over the previous, vital sign (VS)-based classification with respect to mortality outcomes. We also studied the prognostic values of heart rate (HR), systolic blood pressure (SBP), Glasgow Coma Scale (GCS) and base deficit (BD).Methods: The present study is a retrospective analysis at a level I trauma centre between 11 July 2014 and 11 September 2019. Trauma patients (inclusion criteria: trauma team activation, transport directly from scene, no need for resuscitation on scene, precise and detailed medical documentation, age ≥16, 30-day follow-up, complete dataset for HR, SBP, GCS and BD) were allocated to shock classes (I–IV) based on the VS and VS+BD criteria. The predictive values for the classifications were compared with a two-proportion Z-test, while individual parameters were examined with receiver operating characteristic (ROC) analyses.Results: A total of 156 patients met the inclusion criteria out of 60,037 trauma admissions. Both the VS and VS+BD classifications have shown a strong relation to mortality (P=0.0001 vs. P=0.000009). There was no significant difference in their predictive performance. According to the statistical analysis, GCS, BD and SBP showed significant prognostic values (AUCGCS=0.799 [CI: 0.722, 0.875]; AUCBD=0.683, [CI: 0.576, 0.790]; AUCSBP=0.633, [CI: 0.521, 0.744]). HR was found ineffective in predicting mortality. Conclusions: The current ATLS classification for hypovolaemic shock did not appear to be superior to the previous, VS-based classification in our study setting. GCS, BD and SBP were proven to be useful parameters in prognosticating outcome. The role of HR should be reconsidered, since it does not seem to reflect the clinical condition accurately.

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A comparison of base deficit and vital signs in the early assessment of patients with penetrating trauma in a high burden setting

Cited by 25 publications

References 48 publications

Association between base excess and mortality in patients with congestive heart failure

Association between base excess and mortality in patients with congestive heart failure

A protective polymorphism inMMP16, improved blood gas levels, and chronic obstructive pulmonary diseases: Family and two population‐based studies

Comparison of the previous and current trauma-related shock classifications – The more the better? – A retrospective cohort study from a level I trauma centre

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