Abstract
Background: Exsanguination as a syndrome is ill defined. The objectives of this study were to investigate the relationship between survival and patient characteristics - vital signs, factors relating to injury and treatment; determine if threshold levels of pH, temperature, and highest estimated blood loss can predict survival; and identify predictive factors for survival and to initiate damage control. Material and methods: A retrospective 6-year study was conducted, 1993 to 1998. In all, 548 patients met one or more criteria: (1) estimated blood loss ≥2,000 mL during trauma operation; (2) required ≥1,500 mL packed red blood cells (PRBC) during resuscitation; or (3) diagnosis of exsanguination. Analysis was made in two phases: (1) death versus survival in emergency department (ED); (2) death versus survival in operating room (OR). Statistical methods were Fisher's exact test, Student's t test, and logistic regression. Results: For 548 patients, mean Revised Trauma Score 4.38, mean Injury Severity Score 32. Penetrating injuries 82% versus blunt injuries 18%. Vital statistics in emergency department: mean blood pressure 63 mm Hg, heart rate 78 beats per minute. Mean OR pH 7.15 and temperature 34.3°C. Mortality was 379 of 548 (69%). Predictive factors for mortality (means): pH ≤7.2, temperature 4,000 mL, total OR fluid replacement >10,000 mL, estimated blood loss >15 mL/minute (P 2 0.55, concordance 89%). Conclusions: Survival rates can be predicted in exsanguinating patients. "Damage control" should be performed using these criteria. Knowledge of these patterns can be valuable in treatment selection.
| Original language | English |
|---|---|
| Pages (from-to) | 743-751 |
| Number of pages | 9 |
| Journal | American Journal of Surgery |
| Volume | 182 |
| Issue number | 6 |
| DOIs | |
| State | Published - 2001 |
| Externally published | Yes |
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All Science Journal Classification (ASJC) codes
- Surgery
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Reliable variables in the exsanguinated patient which indicate damage control and predict outcome. / Asensio, Juan A.; McDuffie, Lisa; Petrone, Patrizio; Roldán, Gustavo; Forno, Walter; Gambaro, Esteban; Salim, Ali; Demetriades, Demetrios; Murray, James; Velmahos, George; Shoemaker, William; Berne, Thomas V.; Ramicone, Emily; Chan, Linda.
In: American Journal of Surgery, Vol. 182, No. 6, 2001, p. 743-751.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Reliable variables in the exsanguinated patient which indicate damage control and predict outcome
AU - Asensio, Juan A.
AU - McDuffie, Lisa
AU - Petrone, Patrizio
AU - Roldán, Gustavo
AU - Forno, Walter
AU - Gambaro, Esteban
AU - Salim, Ali
AU - Demetriades, Demetrios
AU - Murray, James
AU - Velmahos, George
AU - Shoemaker, William
AU - Berne, Thomas V.
AU - Ramicone, Emily
AU - Chan, Linda
PY - 2001
Y1 - 2001
N2 - Background: Exsanguination as a syndrome is ill defined. The objectives of this study were to investigate the relationship between survival and patient characteristics - vital signs, factors relating to injury and treatment; determine if threshold levels of pH, temperature, and highest estimated blood loss can predict survival; and identify predictive factors for survival and to initiate damage control. Material and methods: A retrospective 6-year study was conducted, 1993 to 1998. In all, 548 patients met one or more criteria: (1) estimated blood loss ≥2,000 mL during trauma operation; (2) required ≥1,500 mL packed red blood cells (PRBC) during resuscitation; or (3) diagnosis of exsanguination. Analysis was made in two phases: (1) death versus survival in emergency department (ED); (2) death versus survival in operating room (OR). Statistical methods were Fisher's exact test, Student's t test, and logistic regression. Results: For 548 patients, mean Revised Trauma Score 4.38, mean Injury Severity Score 32. Penetrating injuries 82% versus blunt injuries 18%. Vital statistics in emergency department: mean blood pressure 63 mm Hg, heart rate 78 beats per minute. Mean OR pH 7.15 and temperature 34.3°C. Mortality was 379 of 548 (69%). Predictive factors for mortality (means): pH ≤7.2, temperature 4,000 mL, total OR fluid replacement >10,000 mL, estimated blood loss >15 mL/minute (P 2 0.55, concordance 89%). Conclusions: Survival rates can be predicted in exsanguinating patients. "Damage control" should be performed using these criteria. Knowledge of these patterns can be valuable in treatment selection.
AB - Background: Exsanguination as a syndrome is ill defined. The objectives of this study were to investigate the relationship between survival and patient characteristics - vital signs, factors relating to injury and treatment; determine if threshold levels of pH, temperature, and highest estimated blood loss can predict survival; and identify predictive factors for survival and to initiate damage control. Material and methods: A retrospective 6-year study was conducted, 1993 to 1998. In all, 548 patients met one or more criteria: (1) estimated blood loss ≥2,000 mL during trauma operation; (2) required ≥1,500 mL packed red blood cells (PRBC) during resuscitation; or (3) diagnosis of exsanguination. Analysis was made in two phases: (1) death versus survival in emergency department (ED); (2) death versus survival in operating room (OR). Statistical methods were Fisher's exact test, Student's t test, and logistic regression. Results: For 548 patients, mean Revised Trauma Score 4.38, mean Injury Severity Score 32. Penetrating injuries 82% versus blunt injuries 18%. Vital statistics in emergency department: mean blood pressure 63 mm Hg, heart rate 78 beats per minute. Mean OR pH 7.15 and temperature 34.3°C. Mortality was 379 of 548 (69%). Predictive factors for mortality (means): pH ≤7.2, temperature 4,000 mL, total OR fluid replacement >10,000 mL, estimated blood loss >15 mL/minute (P 2 0.55, concordance 89%). Conclusions: Survival rates can be predicted in exsanguinating patients. "Damage control" should be performed using these criteria. Knowledge of these patterns can be valuable in treatment selection.
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U2 - 10.1016/S0002-9610(01)00809-1
DO - 10.1016/S0002-9610(01)00809-1
M3 - Article
C2 - 11839351
AN - SCOPUS:0035708654
VL - 182
SP - 743
EP - 751
JO - American Journal of Surgery
JF - American Journal of Surgery
SN - 0002-9610
IS - 6
ER -