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Pilot study of the prevalence, outcomes and detection of occult hypoperfusion in trauma patients
  1. Ogilvie Thom1,
  2. David McD Taylor2,
  3. Rachel E Wolfe3,
  4. Paul Myles4,
  5. Henry Krum5,
  6. Rory Wolfe5
  1. 1Box Hill Hospital, Melbourne, Australia
  2. 2Austin Health, Melbourne, Australia
  3. 3Royal Melbourne Hospital, Melbourne, Australia
  4. 4Alfred Hospital, Melbourne, Australia
  5. 5Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
  1. Correspondence to Dr Ogilvie Thom, Box Hill Hospital, Nelson Road, Box Hill 3128, Australia; Ogilvie.Thom{at}med.monash.edu.au

Abstract

Background Occult hypoperfusion (OH) is defined as hypoperfusion in the presence of normal vital signs. It is associated with increased length of stay (LOS) and increased mortality.

Objectives To compare four methods of detecting OH in adult major trauma patients at a level 1 trauma centre—base excess (BE), non-invasive cardiac index (CI), shock index (SI) and rate over pressure evaluation (ROPE).

Method Patients meeting the Victorian Trauma Registry entrance criteria who presented with normal vital signs were enrolled. CI was obtained half hourly using an USCOM monitor. BE, SI and ROPE were obtained clinically.

Results Sixty-four patients were enrolled. Mean injury severity score (ISS) was 19 (SD 11) and mean hospital LOS was 10 days (SD 8). Two patients (3%) died in hospital. Ten patients (16%) had OH detected by CI, seven (11%) by BE, four (6%) by SI and two (3%) by ROPE. There was a significant association between hospital LOS and BE (p<0.005). Agreement between BE and CI in detecting OH was poor to fair, κ=0.25.

Conclusion OH is associated with increased hospital LOS and occurs in up to 16% of patients. BE performed best as a detection method.

  • cardiac index
  • resuscitation
  • shock
  • trauma

https://doi.org/10.1136/emj.2009.073254

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    Footnotes

    • Funding This study was supported by a project grant from the Transport Accident Commission (TAC). The TAC had no involvement in the study design, collection, analysis and interpretation of data, in the writing of the report or the decision to submit for publication.

    • Competing interests None.

    • Ethics approval This study was conducted with the approval of the Human Research and Ethics Committee, Royal Melbourne Hospital and the Standing Committee on Ethics in Reseach on Humans, Monash University.

    • Provenance and peer review Not commissioned; externally peer reviewed.