Universität zu Köln

Mutschler, Manuel, Nienaber, Ulrike, Wafaisade, Arasch, Brockamp, Thomas, Probst, Christian, Paffrath, Thomas, Bouillon, Bertil and Maegele, Marc (2014). The impact of severe traumatic brain injury on a novel base deficit-based classification of hypovolemic shock. Scand. J. Trauma Resusc. Emerg. Med., 22. LONDON: BMC. ISSN 1757-7241

Full text not available from this repository.

Abstract

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 (R) 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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mutschler, Manuel UNSPECIFIED UNSPECIFIED UNSPECIFIED Nienaber, Ulrike UNSPECIFIED UNSPECIFIED UNSPECIFIED Wafaisade, Arasch UNSPECIFIED UNSPECIFIED UNSPECIFIED Brockamp, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Probst, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffrath, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-440399
DOI:	10.1186/1757-7241-22-28
Journal or Publication Title:	Scand. J. Trauma Resusc. Emerg. Med.
Volume:	22
Date:	2014
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1757-7241
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PEDIATRIC TRAUMA; HEMORRHAGIC-SHOCK; ARTERIAL LACTATE; LIFE-SUPPORT; RESUSCITATION; PREDICTORS; MORTALITY; DEATHS; MARKER Multiple languages Emergency Medicine Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/44039