Initial hematocrit in trauma

Ryan, Mark L.; Thorson, Chad M.; Otero, Christian A.; Vu, Thai; Schulman, Carl I.; Livingstone, Alan S.; Proctor, Kenneth G.

doi:10.1097/ta.0b013e31823d0f35

Cited by 35 publications

(22 citation statements)

References 15 publications

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“…The role of the Hct level, however, is more controversial, with the traditional standpoint of Hct being a more sensitive indicator of acute blood loss than the Hb. The shift of fluid from the interstitial into the intravascular space in the physiological response to blood loss is thought to occur at a more rapid rate, making this parameter more useful over a shorter period of time20). Our data, however, suggests the Hct tends to derange in correlation with the Hb concentration, which is in keeping with the findings of the analysis performed on a large series of trauma patients confirming identical behavior of these particular parameters21).…”

Section: Discussionsupporting

confidence: 88%

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Optimal Timing for Hemoglobin Concentration Determination after Total Knee Arthroplasty: Day 1 versus Day 2

Khalfaoui

Godavitarne

Wilkinson

2017

Knee Surg Relat Res

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PurposePostoperative hemoglobin (Hb) determination remains an essential parameter for quantifying blood loss following total knee replacement (TKR) surgery and guiding transfusion practice. In this study we aimed to ascertain the optimal timing for Hb determination postoperatively and assess its relationship to serum hematocrit (Hct).Materials and MethodsThis was a retrospective cohort analysis of 61 consecutive patients undergoing preoperative, day 1 and day 2 Hb and Hct concentration determination following TKR surgery. This was a single centre study in the United Kingdom.ResultsThe mean fall in Hb concentration at day 1 was 2.9 g/dL in comparison to 3.3 g/dL at day 2. This indicated a significant difference of 0.39 g/dL (p=0.023). A total of 5 patients required blood transfusions following day 2 Hb determination. Postoperative Hct values varied in close relation with the Hb concentration with no significant differences demonstrated. Our study reveals a significant change between day 1 and day 2 Hb concentrations following TKR surgery, with no significant differing information provided through Hct determination.ConclusionsOur results support the use of delayed routine testing at day 2 following surgery as it is likely to more accurately reflect ongoing hidden blood loss into the joint cavity and within soft tissue planes.

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Section: Discussionsupporting

confidence: 88%

“…In this context, the Hb concentration is generally deemed to be inaccurate at defining the degree of acute blood loss20,21). The role of the Hct level, however, is more controversial, with the traditional standpoint of Hct being a more sensitive indicator of acute blood loss than the Hb.…”

Section: Discussionmentioning

confidence: 99%

Optimal Timing for Hemoglobin Concentration Determination after Total Knee Arthroplasty: Day 1 versus Day 2

Khalfaoui

Godavitarne

Wilkinson

2017

Knee Surg Relat Res

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“…In a retrospective study of 196 trauma patients, Ryan et al . [117] found that Hct at admission closely correlates with haemorrhagic shock. However, this study included severe cases requiring emergency surgery only (most with penetrating injuries), and may not be applicable to the general trauma patient population.…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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“…Ryan et al retrospectively reviewed admission hematocrit (HCT) with the need for transfusion and vasopressor support among trauma patients requiring emergency surgery. The authors found that in this cohort of patients admission HCT as low as 37 % was predictive of the need for additional hemodynamic support [86]. Interestingly, they found that traditional markers of shock, including pulse and respiratory rate, were not predictors for necessitating further hemodynamic support.…”

Section: Blood Productsmentioning

confidence: 81%

Volume Management and Resuscitation in Trauma

Bradley

Nelson

2014

Curr Anesthesiol Rep

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Trauma remains an enormous burden on the American medical system. While patients of all ages sustain severe trauma, it remains the most common cause of death in young adults. Exsanguination from uncontrolled hemorrhage is the leading cause of preventable death among the traumatically injured. The lethal triad of trauma is a culmination of coagulopathy, acidosis, and hypothermia that can rapidly deteriorate and lead to a patient's demise if not treated accordingly. The goal of trauma resuscitation is to prevent or halt this triad while minimizing iatrogenic injury. The provider has many options available in his armamentarium for resuscitation, but each carries its own risks and benefits. Over the past two decades, trauma research has given us a better understanding of and improved management strategies for this triad. This chapter will explore the various resuscitative options available and summarize the most recent literature regarding their use.

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Initial hematocrit in trauma

Abstract: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.

Cited by 35 publications

References 15 publications

Optimal Timing for Hemoglobin Concentration Determination after Total Knee Arthroplasty: Day 1 versus Day 2

Optimal Timing for Hemoglobin Concentration Determination after Total Knee Arthroplasty: Day 1 versus Day 2

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Volume Management and Resuscitation in Trauma

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