PhD Scientific Days 2020

Clinical Medicine I. Lectures

Comparison of the Previous and Current Trauma-Related Shock Classifications – The More the Better? – A Retrospective Cohort Study From a Level I Trauma Center

Előadó neve

Dr. Jávor, Péter

Előadó munkahelye

Department of Traumatology, University of Szeged, Szeged, Hungary

Előadó telefonszáma

+36703193420

Előadó e-mail címe

javorpeter25@gmail.com

Az előadás címe

Comparison of the Previous and Current Trauma-Related Shock Classifications – The More the Better? – A Retrospective Cohort Study From a Level I Trauma Center

Szerző(k) neve és munkahelye

Peter Javor1, Endre Csonka1, Edina Butt1, Ferenc Rárosi2, Barna Babik3, Endre Varga1, Petra Hartmann1,4

1 Department of Traumatology, University of Szeged, Szeged, Hungary
2 Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
3 Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
4 Institute of Surgical Research, University of Szeged, Szeged, Hungary

Szekció

Clinical Medicine I. Lectures

Language of the presentation

English

Section, first choice

Clinical Medicine

Section, second choice

Health Sciences

Összefoglaló szövege

Introduction: According to the previous Advanced Trauma Life Support (ATLS) guidance, the early assessment and classification of trauma patients with haemorrhage were based upon the vital signs (heart rate (HR), systolic blood pressure (SBP), Glasgow Coma Scale (GCS)). Recently, national trauma registry analyses suggested to extend the assessment criteria with the base deficit (BD), referring to the metabolic status. Although commonly used, the relevance of BD is still controversial.
Aims: The study aim was to compare the predictive performance of the previous, vital sign based (VS) and the current, extended (VS+BD) criteria of classification with respect to the outcomes of mortality. We also studied the predictive values of the individual parameters (HR, SBP, GCS, BD) respectively.
Methods: Retrospective analysis from a level I trauma center. Data were collected on trauma patients that met the inclusion criteria (trauma team activation, age ≥ 12, 30-day follow up, complete dataset of VS and BD). They were assigned into shock classes (I-IV) based on their worst parameter from VS and VS+BD criteria, respectively. Chi-square tests and a two-proportion Z-test were performed to calculate and compare the predictive performance of VS and VS+BD classifications. Receiver operating characteristic (ROC) curve was calculated for each variable.
Results: A total of 156 patients met the inclusion criteria. 34 patients died within the first 30 days, resulting a mortality rate of 21.79%. Both classifications have shown strong relation with mortality (p=0,000021 vs. p=0,000009). There was no significant difference in their performance predicting mortality (p=0.981). According to our ROC-analysis, GCS, BD and SBP had significant predictive values (AUROC curves [95% CI]: GCS: 0.799, [0.722,0.875]; BD: 0.683, [0.576,0.790]; SBP: 0.633, [0.521,0.744]). HR was found ineffective in predicting mortality. (AUROC: 0.595, [0.480,0.710]).
Conclusions: According to our study, the current ATLS classification of hypovolaemic shock does not appear to be superior to the previous, vital sign based one in predicting mortality in a setting where only the worst parameter of patients determines their shock class. The analysis of the individual parameters showed that GCS, BD and SBP have a significant predictive potential. HR does not seem to reflect the clinical condition accurately.

Additional Information

Petra Hartmann
drhartmann.petra@gmail.com

Bemutatás módja

Szóbeli

Kind

Szabad

Status

elfogadva

Accepted presentation method

szóbeli

Előadás fájl jóváhagyás

nem rendelkezett róla

Előadó

4658

Start

10:35

End

10:50

Authors (legacy)

Peter Javor1, Endre Csonka1, Edina Butt1, Ferenc Rárosi2, Barna Babik3, Endre Varga1, Petra Hartmann1,4

1 Department of Traumatology, University of Szeged, Szeged, Hungary
2 Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
3 Department of Anaesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
4 Institute of Surgical Research, University of Szeged, Szeged, Hungary