Base deficit as a marker of survival after traumatic injury

• DOI: 10.1097/ta.0b013e31824ef9d2
• Publication Date: 2015-10-14T18:52:42Z
• Authors: Erica I. Hodgman; Bryan C. Morse; Christopher J. Dente; Michael J. Mina; Beth H. Shaz; Jeffrey M. Nicholas; Amy D. Wyrzykowski; Jeffrey P. Salomone; Grace S. Rozycki; David V. Feliciano
• Keywords: Adult; Male; Resuscitation; Prognosis; Survival Analysis; 3. Good health; 03 medical and health sciences; Injury Severity Score; Treatment Outcome; 0302 clinical medicine; Humans; Wounds and Injuries; Acidosis, Lactic; Blood Transfusion; Female; Biomarkers; Retrospective Studies

BACKGROUND: Damage control resuscitation (DCR) has improved outcomes in severely injured patients. In civilian centers, massive transfusion protocols (MTPs) represent the most formal application of DCR principles, ensuring early, accurate delivery high fixed ratios blood components. Recent data suggest that may also help address early trauma-induced coagulopathy. Finally, base deficit (BD) is a long-recognized and simple prognostic marker survival after injury. METHODS: Outcomes patients with admission BD resuscitated during era (2007–2010) were compared previously published (1995–2003) cared for before (pre-DCR). Patients considered to have no hypoperfusion (BD, >−6), mild −6 −14.9), moderate −15 −23.9), or severe <−24). RESULTS: Of 6,767 patients, 4,561 treated pre-DCR 2,206 era. latter, 218 (9.8%) represented activations MTP. tended be slightly older, more likely victims penetrating trauma, as measured by trauma scores BD. Despite these differences, overall was unchanged two eras (86.4% vs. 85.7%, p = 0.67), curves stratified mechanism injury nearly identical. who using MTP, however, experienced substantial increase counterparts. CONCLUSION: limited adoption DCR, injury, BD, identical modern deranged physiology, experience better outcomes. remains consistent predictor mortality traumatic Predicted depends on energy level (stab wound nonstab wound) than (blunt penetrating). LEVEL OF EVIDENCE: IV, therapeutic/prognostic study.