Comparison of Base Deficit and Vital Signs as Criteria for Hemorrhagic Shock Classification in Children with Trauma

Abstract

Purpose Base deficit (BD) is superior to vital signs in predicting trauma outcomes in adults. The authors aimed to compare BD and vital signs as criteria for the four-tiered hemorrhagic shock classification in children with trauma. Materials and Methods We retrospectively reviewed the data of 1046 injured children who visited a Korean academic hospital from 2010 through 2018. These children were classified separately based on BD (class I, BD ≤2.0 mmol/L; II, 2.1–6.0 mmol/L; III, 6.1–10 mmol/L; and IV, ≥10.1 mmol/L) and vital signs (<13 years: age-adjusted hypotension and tachycardia, and Glasgow Coma Scale; 13–17 years: the 2012 Advanced Trauma Life Support classification). The two methods were compared on a class-by-class basis regarding the outcomes: mortality, early transfusion (overall and massive), and early surgical interventions for the torso or major vessels. Results In total, 603 children were enrolled, of whom 6.6% died. With the worsening of BD and vital signs, the outcome rates increased stepwise (most p <0.001; only between surgical interventions and vital signs, p =0.035). Mortality more commonly occurred in BD-based class IV than in vital signs-based class IV (58.8% vs. 32.7%, p =0.008). Early transfusion was more commonly performed in BD-based class III than in vital signs-based class III (overall, 73.8% vs. 53.7%, p =0.007; massive, 37.5% vs. 15.8%, p =0.001). No significant differences were found in the rates of early surgical interventions between the two methods. Conclusion BD can be a better predictor of outcomes than vital signs in children with severe hemorrhagic shock.

Assessment of shock in emergency: Narrative Review

“…Besides clinical parameter biochemical parameters like lactate and base deficit are important in the assessment of shock. [40][41][42][43] After the initial resuscitation, assessment of peripheral perfusion which physical examination can identify the hemodynamically stable patient with severe organ dysfunction and higher lactate. Therefore a patient with abnormal peripheral perfusion following initial resuscitation can be taken as a risk factor for worsening organ failure.…”

“…42 Base deficit was found to be a better predictor than vital signs in pediatric hemorrhagic shock. 43…”

Impact of Intubator’s Training Level on First-Pass Success of Endotracheal Intubation in Acute Care Settings: A Four-Center Retrospective Study

“…Patient-level variables included the age (months) with proportions of infants, sex, overall and critical comorbidities, high acuity [ 13 ], trauma, crash airway, pre-intubation physiologic abnormalities [ 14 ], and indications for intubation (respiratory compromise, altered mental status, cardiac arrest, and shock). We analyzed the physiologic abnormalities, considering the rarity of study using such variables.…”

“…* Refer to the definitions and details in Tables S2 and S3 , respectively. † Refer to the definition of the pre-intubation physiologic abnormalities in Table S2 [ 14 ]. ‡ Only one 13-month-old febrile boy with pneumomediastinum was intubated at an intensive care unit to prepare endoscopy and later demonstrated a laryngeal injury.…”

“…[14]. ‡ Only one 13-month-old febrile boy with pneumomediastinum was intubated at an intensive care unit to prepare endoscopy and later demonstrated a laryngeal injury.…”