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Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock

Abt, Rahel ; Lustenberger, Thomas ; Stover, John ; Benninger, Emanuel ; Lenzlinger, Philipp ; Stocker, Reto ; Keel, Marius

In: European Journal of Trauma and Emergency Surgery, 2009, vol. 35, no. 5, p. 429-436

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    Titre
    • Base excess determined within one hour of admission predicts mortality in patients with severe pelvic fractures and severe hemorrhagic shock
    Auteur
    • Abt, Rahel. Center for Clinical Research, University Hospital Zürich, Zürich, Switzerland
    • Lustenberger, Thomas. Center for Clinical Research, University Hospital Zürich, Zürich, Switzerland
    • Stover, John. Surgical Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
    • Benninger, Emanuel. Center for Clinical Research, University Hospital Zürich, Zürich, Switzerland
    • Lenzlinger, Philipp. Center for Clinical Research, University Hospital Zürich, Zürich, Switzerland
    • Stocker, Reto. Surgical Intensive Care Medicine, University Hospital Zürich, Zürich, Switzerland
    • Keel, Marius. Center for Clinical Research, University Hospital Zürich, Zürich, Switzerland
    Type de document
    • Postprint
    Langue
    • Inglese
    Publié dans
    • European Journal of Trauma and Emergency Surgery, 2009, vol. 35, no. 5, p. 429-436. Urban and Vogel
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:312716
    Summary
    Abstract : Background: : Unstable pelvic ring fractures with exsanguinating hemorrhages are rare but potentially lifethreatening injuries. The aim of this retrospective study was to evaluate whether early changes in acid- base parameters predict mortality of patients with severe pelvic trauma and hemorrhagic shock. Methods: : Data for 50 patients with pelvic ring disruption and severe hemorrhage were analyzed retrospectively. In all patients, the pelvic ring was temporarily stabilized by C-clamp. Patients with ongoing bleeding underwent laparotomy with extra and/or intraperitoneal pelvic packing, as required. Base excess, lactate, and pH were measured upon admission and at 1, 2, 3, 4, 6, 8, and 12 h postadmission. Patients were categorized as early survivors (surviving the first 12 h after admission) and nonsurvivors. Statistical analysis was performed by Mann-Whitney test; significance was assumed at p < 0.05. Receiver operating characteristic curves were generated for early mortality from each acid-base variable. Results: : Sixteen patients (32%) were nonsurvivors due to hemorrhagic shock (n = 13) or severe traumatic brain injury (n = 3). Thirty-four patients were early survivors. Base excess, lactate, and pH significantly discriminated between early survivors and nonsurvivors. Base excess determined 1 h after admission discriminated most strongly, with an area under the receiver operating characteristic curve of 0.915 (95% confidence interval, 0.836-0.993; p < 0.001). Conclusion: : Base excess, lactate, and pH discriminate early survivors from nonsurvivors suffering from severe pelvic trauma and hemorrhagic shock. Base excess measured 1 h after admission best predicted early mortality following pelvic trauma with concomitant hemorrhage