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The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock.
Scand J Trauma Resusc Emerg Med. 2014 Apr 30; 22:28.SJ

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 AIShead ≥ 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 (AIShead ≥ 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.

Authors+Show Affiliations

Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimer Str, 200, D-51109 Cologne, Germany. manuelmutschler@web.de.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24779431

Citation

Mutschler, Manuel, et al. "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, vol. 22, 2014, p. 28.
Mutschler M, Nienaber U, Wafaisade A, et al. The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock. Scand J Trauma Resusc Emerg Med. 2014;22:28.
Mutschler, M., Nienaber, U., Wafaisade, A., Brockamp, T., Probst, C., Paffrath, T., Bouillon, B., & Maegele, M. (2014). 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, 22, 28. https://doi.org/10.1186/1757-7241-22-28
Mutschler M, et al. The Impact of Severe Traumatic Brain Injury On a Novel Base Deficit- Based Classification of Hypovolemic Shock. Scand J Trauma Resusc Emerg Med. 2014 Apr 30;22:28. PubMed PMID: 24779431.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The impact of severe traumatic brain injury on a novel base deficit- based classification of hypovolemic shock. AU - Mutschler,Manuel, AU - Nienaber,Ulrike, AU - Wafaisade,Arasch, AU - Brockamp,Thomas, AU - Probst,Christian, AU - Paffrath,Thomas, AU - Bouillon,Bertil, AU - Maegele,Marc, AU - ,, Y1 - 2014/04/30/ PY - 2013/08/05/received PY - 2014/04/23/accepted PY - 2014/5/1/entrez PY - 2014/5/2/pubmed PY - 2014/11/7/medline SP - 28 EP - 28 JF - Scandinavian journal of trauma, resuscitation and emergency medicine JO - Scand J Trauma Resusc Emerg Med VL - 22 N2 - 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 AIShead ≥ 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 (AIShead ≥ 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. SN - 1757-7241 UR - https://www.unboundmedicine.com/medline/citation/24779431/The_impact_of_severe_traumatic_brain_injury_on_a_novel_base_deficit__based_classification_of_hypovolemic_shock_ L2 - https://sjtrem.biomedcentral.com/articles/10.1186/1757-7241-22-28 DB - PRIME DP - Unbound Medicine ER -