Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 12 , ISSUE 1 ( January-April, 2023 ) > List of Articles


Shock Index, Lactate, and Base Deficit as Bleeding Predictors in Trauma Patients from a Complex Emergency Department: A Prospective Cohort Study

Nicolas Solano Arboleda, Alexei Rojas Diaz, Alvaro J Zuñiga, Angela Merchan-Galvis

Keywords : Base deficit, Blood gas analysis, Emergencies, Hemorrhage, Lactic acid, Shock, Shock index, Wounds and injuries

Citation Information : Arboleda NS, Diaz AR, Zuñiga AJ, Merchan-Galvis A. Shock Index, Lactate, and Base Deficit as Bleeding Predictors in Trauma Patients from a Complex Emergency Department: A Prospective Cohort Study. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):42-46.

DOI: 10.5005/jp-journals-10030-1416

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Hemorrhagic shock (HS) is the leading preventable cause of death in trauma patients. Shock index (SI), lactate, and base deficit (BD) are suggested to be rapid markers for triage tools; this study aimed to assess whether these tools can identify bleeding and predict specific outcomes in trauma patients. Methods: A prospective cohort of trauma patients from a complex Emergency Department were analyzed between October 2019 and March 2020. Sociodemographic and clinical data, prehospital care, vital signs, arterial blood gases on admission, and 30-day follow-ups were collected. Evidence of significant bleeding was defined as physical or imaging findings of significant bleeding that led to blood transfusions, hemostatic surgery, and death due to hypovolemic shock. Results: Out of the 111 patients aged 35 ± 16.2 years (97% male), 72% had nonpenetrating trauma, and 63% had high-energy trauma, with a mean injury severity score (ISS) of 15.8 ± 14.1, and revised trauma score (RTS) 7.3 ± 1.3. The cut-off points for bleeding were determined by the following—SI > 0.9 with an area under the curve (AUC) of 0.64 [95% confidence interval (CI) 0.541–0.743]; lactate levels >2 with an AUC of 0.77 [95% CI 0.695–0.864], and a BD <−6 with an AUC of 0.74 [95% CI 0.657–0.839]. The sensitivity was 32.4, 76.5, and 64.7%, and the specificity was 93, 62.8, and 79.1%, respectively. Conclusion: Base deficit (BD) and lactate are good triage tools for identifying HS in trauma patients.

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