TITLE

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

AUTHOR(S)
Abt, Rahel; Lustenberger, Thomas; Stover, John F.; Benninger, Emanuel; Lenzlinger, Philipp M.; Stocker, Reto; Keel, Marius
PUB. DATE
October 2009
SOURCE
European Journal of Trauma & Emergency Surgery;Oct2009, Vol. 35 Issue 5, p429
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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. 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. 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). 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.
ACCESSION #
44799855

 

Related Articles

  • Blunt Abdominal Trauma Requiring Laparotomy: an Analysis of 342 Polytraumatized Patients. Hildebrand, Frank; Winkler, Michael; van Griensven, Martijn; Probst, Christian; Musahl, Volker; Krettek, Christian; Pape, Hans-Christoph // European Journal of Trauma;Oct2006, Vol. 32 Issue 5, p430 

    Hemorrhage due to abdominal trauma is one of the most frequent causes of early mortality in polytraumatized patients. Therefore, the initial management of abdominal trauma is an important factor in determining the outcome. The aim of this study was to evaluate the clinical course in multiple...

  • Tuberkuloza jetre kao rijedak uzrok masivnog intrabdominalnog krvarenja. Čustović, Samir; Pandža, Haris; Leto, Hasan; Šehović, Jelena // Medical Archives / Medicinski Arhiv;2007, Vol. 61 Issue 3, p184 

    We admitted 70 years old woman with signs of acute abdomen and severe hemorrhagic shock. The urgent laparatomy was done. We found necrosis of the right liver lobe with signs of diffuse hepatic disease. We removed necrotic liver tissue and applied perihepatic package in order to stop bleeding....

  • Fatal Hyperkalemia Due to Rapid Red Cell Transfusion in a Critically Ill Patient. Tsukamoto, Sakiko; Maruyama, Koichi; Nakagawa, Hideyuki; Iwase, Yoshinori; Kitamura, Akira; Hayashida, Masakazu // Journal of Nippon Medical School;2009, Vol. 76 Issue 5, p258 

    A 60-year-old woman in severe hemorrhagic shock underwent urgent laparotomy to control massive hematemesis. Severe metabolic acidosis due to hemorrhagic shock and hyperkalemia as well as hypocalcemia associated with rapid blood transfusion were aggressively corrected with administration of...

  • Lessons learned from the outcome of bloodless emergency laparotomies on Jehovah’s Witness women presenting in the extremis with ruptured uterus. Chigbu, B.; Onwere, S.; Kamanu, C.; Aluka, C.; Okoro, O.; Feyi-Waboso, P.; Onichakwe, C. // Archives of Gynecology & Obstetrics;Apr2009, Vol. 279 Issue 4, p469 

    We compared the outcomes of bloodless emergency laparotomies for uterine rupture in twenty Jehovah’s Witness (JW) women who were in a state of haemorrhagic shock with 45 other women who received blood transfusion. The case records of twenty Jehovah’s Witness patients, who underwent...

  • Postpartum haemorrhage following manual removal of retained placenta from an inverted uterus and the role of mersilene tape: Lessons to learn. Ngene, Nnabuike Chibuoke // Obstetrics & Gynaecology Forum;Aug2014, Vol. 24 Issue 3, p13 

    Acute uterine inversion (AUI) is a rare obstetric emergency. Manual removal of placenta in such circumstances often leads to massive postpartum haemorrhage (PPH) if the procedure is performed before correction of the inversion. In the case reported, a 20 year old G3, P1+1 at term, had a...

  • Retroperitoneal hemorrhagic shock in a patient on warfarin therapy. Subramanian, Sankar; Gounder, Subramanian Marappa; Thirunarayanan, Arunkumar; Kannan, Anand; Venu, Nandigam // Journal of Emergencies, Trauma & Shock;May2009, Vol. 2 Issue 2, p137 

    Oral anticoagulants are an established treatment modality in the prophylaxis of thromboembolic events in various clinical scenarios. Needless to say that, bleeding is a natural adverse effect of this drug. Most of the times bleeding is inconsequential. But nevertheless massive and fatal bleeding...

  • Acute respiratory distress and hemorrhagic shock in a patient 12 days after elective hepatic surgery. Xirouchaki, Nektaria; Mavrogeni, Eleni; Kondili, Eumorfia; Georgopoulos, Dimitris // Intensive Care Medicine;Feb2007, Vol. 33 Issue 2, p368 

    The article describes the case of a 69-year-old woman with acute respiratory distress and hemorrhagic shock 12 days after elective hepatic surgery. She was admitted to the Surgical Department for elective cholecystectomy and enucleation of a large hepatic hemangioma. She was diagnosed of having...

  • Uterine rupture following incomplete molar pregnancy: a case report. Pourali, Leila; Ayati, Sedigheh; Vahidroodsari, Fatemeh; Taghizadeh, Ali; Sadat Hosseini, Reyhane // Tehran University Medical Journal;Mar2013, Vol. 70 Issue 12, p798 

    Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non...

  • An outcome prediction model for exsanguinating patients with blunt abdominal trauma after damage control laparotomy: a retrospective study. Shang-Yu Wang; Chien-Hung Liao; Chih-Yuan Fu; Shih-Ching Kang; Chun-Hsiang Ouyang; I-Ming Kuo; Jr-Rung Lin; Yu-Pao Hsu; Chun-Nan Yeh; Shao-Wei Chen // BMC Surgery;2014, Vol. 14 Issue 1, p1 

    Background We present a series of patients with blunt abdominal trauma who underwent damage control laparotomy (DCL) and introduce a nomogram that we created to predict survival among these patients. Methods This was a retrospective study. From January 2002 to June 2012, 91 patients underwent...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics