Is arterial base deficit still a useful prognostic marker in trauma? A systematic review

Ibrahim, Irwani; Chor, Wei Ping Daniel; Chue, Koy Min; Tan, Chuen Seng; Tan, Haining; Siddiqui, Fahad Javaid; Hartman, Mikael

doi:10.1016/j.ajem.2015.12.012

Cited by 59 publications

(62 citation statements)

References 45 publications

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“…A previous study showed that these factors proved to be significant factors for in-hospital or 30-day mortality. [9,[20][21][22] In addition, the results indicated that they can also be used as the factors for early mortality.…”

Section: Discussionmentioning

confidence: 98%

“…The cutoffs were the 3 GAP groups (mild, moderate, and severe), INR 1.5, platelet count <100,000/µL, base excess -6, and the 6 saturation groups (>91%, 90-81%, 80-71%, 70-61%, 60-51%, <50%) derived in previous studies. [1,9,[20][21][22] A p value <0.05 was considered statistically significant. MedCalc 17 (MedCalc BVBA, Ostend, Belgium) and Stata version 13 (StataCorp LP, College Station, TX, USA) software were used for the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have confirmed that BD significantly predicts mortality in trauma patients, despite recent advances in such treatment. [21] A higher BD suggests severe traumatic injury [34,35] and is associated with complications, such as MOF, adult respiratory distress syndrome, acute lung injury, and renal failure coagulopathy. [36][37][38] We also found that BD significantly predicted 24-hour mortality.…”

Section: Discussionmentioning

confidence: 99%

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Factors predicting the early mortality of trauma patients

Jin¹

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND:The aim of this study was to identify factors predicting early mortality in trauma patients. METHODS:This was a study of 6288 trauma patients admitted to the hospital between July 2011 and June 2016. Among the variables recorded for a prospective trauma registry, the following were selected for analysis: sex; age; a combination of the Glasgow Coma Scale score, age, and systolic blood pressure (SBP) (GAP); a combination of the mechanism of injury, the Glasgow Coma Scale score, age, and SBP (MGAP); SBP; respiratory rate; peripheral oxygen saturation (SpO 2 value); the Glasgow Coma Scale score; laboratory variables; and presentation time. Logistic regression analysis was used to explore associations between these variables and early mortality. RESULTS:In total, 296 (4.6%) patients died within 24 hours. Univariate regression analysis indicated that age, the GAP, the MGAP, SBP, SpO 2 , the Glasgow Coma Scale score, base excess, hemoglobin level, platelet count, INR, and presentation time predicted early mortality. Multivariate regression showed that the GAP, the MGAP, SpO 2 , base excess, platelet count, and INR were independently predictive. The areas under the receiver operator curve comparisons for the GAP and MGAP models revealed the superiority of the GAP-based model. CONCLUSION:The GAP model, SpO 2 , base excess, platelet count, and INR predicted the early mortality of trauma patients.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Factors predicting the early mortality of trauma patients

Jin¹

2018

Ulus Travma Acil Cerrahi Derg

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“…Greater changes indicate the presence of more severe underlying diseases. The BE value is a good indication of metabolic compensation [17, 18, 31–34]. Both negative and positive values are warning signs of the severity of illness.…”

Section: Discussionmentioning

confidence: 99%

“…Objective evaluation of the severity of dyspnea is crucial in EDs, but unfortunately, we do not have any single, “magic” parameter which would describe correctly the severity of dyspnea. For objectification, a plausible solution is to choose pH, base excess (BE) and lactate levels in combination, because all of these are easily available in an emergency setting and characterize very well the severity of the patients’ different illnesses [17–25]. …”

Section: Introductionmentioning

confidence: 99%

Estimation of the severity of breathlessness in the emergency department: a dyspnea score

et al. 2016

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BackgroundDyspnea is a frequent complaint in emergency departments (ED). It has a significant amount of subjective and affective components, therefore the dyspnea scores, based on the patients’ rating, can be ambiguous. Our purpose was to develop and validate a simple scoring system to evaluate the severity of dyspnea in emergency care, based on objectively measured parameters.MethodsWe performed a double center, prospective, observational study including 350 patients who were admitted in EDs with dyspnea. We evaluated the patients’ subjective feeling about dyspnea and applied our Dyspnea Severity Score (DSS), rating the dyspnea in 7 Dimensions from 0 to 3 points. The DSS was validated using the deterioration of pH, base-excess and lactate levels in the blood gas samples (Objective Classification Scale (OCS) 9 points and 13 points groups).ResultsAll of the Dimensions correlated closely with the OCS values and with the subjective feeling of the dyspnea. Using multiple linear regression analysis we were able to decrease the numbers of Dimensions from seven to four without causing a significant change in the determination coefficient in any OCS groups. This reduced DSS values (exercise tolerance, cooperation, cyanosis, SpO2 value) showed high sensitivity and specificity to predict the values of OCS groups (the ranges: AUC 0.77–0.99, sensitivity 65–100%, specificity 64–99%). There was a close correlation between the subjective dyspnea scores and the OCS point values (p < 0.001), though the scatter was very large.ConclusionsA new DSS was validated which score is suitable to compare the severity of dyspnea among different patients and different illnesses. The simplified version of the score (its value ≥7 points without correction factors) can be useful at the triage or in pre-hospital care.

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Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery

Roberts,

Barber,

Temkin

et al. 2024

JAMA Surg

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ImportanceTraumatic brain injury (TBI) is associated with persistent functional and cognitive deficits, which may be susceptible to secondary insults. The implications of exposure to surgery and anesthesia after TBI warrant investigation, given that surgery has been associated with neurocognitive disorders.ObjectiveTo examine whether exposure to extracranial (EC) surgery and anesthesia is related to worse functional and cognitive outcomes after TBI.Design, Setting, and ParticipantsThis study was a retrospective, secondary analysis of data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, a prospective cohort study that assessed longitudinal outcomes of participants enrolled at 18 level I US trauma centers between February 1, 2014, and August 31, 2018. Participants were 17 years or older, presented within 24 hours of trauma, were admitted to an inpatient unit from the emergency department, had known Glasgow Coma Scale (GCS) and head computed tomography (CT) status, and did not undergo cranial surgery. This analysis was conducted between January 2, 2020, and August 8, 2023.ExposureParticipants who underwent EC surgery during the index admission were compared with participants with no surgery in groups with a peripheral orthopedic injury or a TBI and were classified as having uncomplicated mild TBI (GCS score of 13-15 and negative CT results [CT− mTBI]), complicated mild TBI (GCS score of 13-15 and positive CT results [CT+ mTBI]), or moderate to severe TBI (GCS score of 3-12 [m/sTBI]).Main Outcomes and MeasuresThe primary outcomes were functional limitations quantified by the Glasgow Outcome Scale–Extended for all injuries (GOSE-ALL) and brain injury (GOSE-TBI) and neurocognitive outcomes at 2 weeks and 6 months after injury.ResultsA total of 1835 participants (mean [SD] age, 42.2 [17.8] years; 1279 [70%] male; 299 Black, 1412 White, and 96 other) were analyzed, including 1349 nonsurgical participants and 486 participants undergoing EC surgery. The participants undergoing EC surgery across all TBI severities had significantly worse GOSE-ALL scores at 2 weeks and 6 months compared with their nonsurgical counterparts. At 6 months after injury, m/sTBI and CT+ mTBI participants who underwent EC surgery had significantly worse GOSE-TBI scores (B = −1.11 [95% CI, −1.53 to −0.68] in participants with m/sTBI and −0.39 [95% CI, −0.77 to −0.01] in participants with CT+ mTBI) and performed worse on the Trail Making Test Part B (B = 30.1 [95% CI, 11.9-48.2] in participants with m/sTBI and 26.3 [95% CI, 11.3-41.2] in participants with CT+ mTBI).Conclusions and RelevanceThis study found that exposure to EC surgery and anesthesia was associated with adverse functional outcomes and impaired executive function after TBI. This unfavorable association warrants further investigation of the potential mechanisms and clinical implications that could inform decisions regarding the timing of surgical interventions in patients after TBI.

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Is arterial base deficit still a useful prognostic marker in trauma? A systematic review

Cited by 59 publications

References 45 publications

Factors predicting the early mortality of trauma patients

Factors predicting the early mortality of trauma patients

Estimation of the severity of breathlessness in the emergency department: a dyspnea score

Clinical Outcomes After Traumatic Brain Injury and Exposure to Extracranial Surgery

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