The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Marc Maegele²  Bertil Bouillon²  Thomas Paffrath²  Christian Probst²  Thomas Brockamp²  Arasch Wafaisade²  Ulrike Nienaber¹  Manuel Mutschler³ 

[1] Academy for Trauma Surgery, Straße des 17.Juni 106-108, D-10623 Berlin, Germany;Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany;Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Ostmerheimer Str. 200, D-51109 Cologne, Germany

关键词: Traumatic brain injury;    Transfusion;    Base deficit;    Vital signs;    Classification;    Shock;    Trauma;   

Others  :  803699
DOI  :  10.1186/1757-7241-22-28

 received in 2013-08-05, accepted in 2014-04-23,  发布年份 2014

【 摘 要 】

Background

Recently, our group has proposed a new classification of hypovolemic shock based on the physiological shock marker base deficit (BD). The classification consists of four groups of worsening BD and correlates with the extent of hypovolemic shock in severely injured patients. The aim of this study was to test the applicability of our recently proposed classification of hypovolemic shock in the context of severe traumatic brain injury (TBI).

Methods

Between 2002 and 2011, patients ≥16 years in age with an AIS_head ≥ 3 have been retrieved from the German TraumaRegister DGU® database. Patients were classified into four strata of worsening BD [(class I (BD ≤ 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class IV (BD > 10 mmol/l)] and assessed for demographic and injury characteristics as well as blood product transfusions and outcomes. The cohort of severely injured patients with TBI was compared to a population of all trauma patients to assess possible differences in the applicability of the BD based classification of hypovolemic shock.

Results

From a total of 23,496 patients, 10,201 multiply injured patients with TBI (AIS_head ≥ 3) could be identified. With worsening of BD, a consecutive increase of mortality rate from 15.9% in class I to 61.4% in class IV patients was observed. Simultaneously, injury severity scores increased from 20.8 (±11.9) to 41.6 (±17). Increments in BD paralleled decreasing hemoglobin, platelet counts and Quick’s values. The number of blood units transfused correlated with worsening of BD. Massive transfusion rates increased from 5% in class I to 47% in class IV. Between multiply injured patients with TBI and all trauma patients, no clinically relevant differences in transfusion requirement or massive transfusion rates were observed.

Conclusion

The presence of TBI has no relevant impact on the applicability of the recently proposed BD-based classification of hypovolemic shock. This study underlines the role of BD as a relevant clinical indicator of hypovolaemic shock during the initial assessment in respect to haemostatic resuscitation and transfusion requirements.

【 授权许可】

   
2014 Mutschler et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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