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Ionised calcium levels in major trauma patients who received blood en route to a military medical treatment facility
  1. Tony Kyle1,2,
  2. Ian Greaves1,3,
  3. Anthony Beynon4,5,
  4. Vicky Whittaker6,
  5. Mike Brewer7,
  6. Jason Smith1,4
  1. 1 Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research and Academia), Birmingham, UK
  2. 2 Institute of Learning Research & Innovation, James Cook University Hospital, Middlebrough, UK
  3. 3 Emergency Department, James Cook University Hospital, Middlesbrough, UK
  4. 4 Emergency Department, Derriford Hospital, Plymouth, UK
  5. 5 Defence Medical Group South West, Derriford Hospital, Plymouth, UK
  6. 6 Health and Social Care Institute, Teesside University, Middlesbrough, North Yorkshire, UK
  7. 7 Department of Biomedical Science, 16 Medical Regiment, Colchester, UK
  1. Correspondence to Tony Kyle, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham B15 2SQ, UK; tony.kyle{at}


Background Hypocalcaemia is a common metabolic derangement in critically ill patients. Blood transfusion can also contribute to depleted calcium levels. The aims of this study were to identify the incidence of hypocalcaemia in military trauma patients receiving blood products en route to a deployed hospital facility and to determine if intravenous calcium, given during the prehospital phase, has an effect on admission calcium levels.

Methods This was a retrospective review of patients transported by the UK Medical Emergency Response Team in Afghanistan between January 2010 and December 2014 who were treated with blood products in the prehospital setting. Total units of blood products administered, basic demographics, Injury Severity Score and trauma type were collected. Ionised serum calcium levels on admission to hospital were compared between those who received blood products without prehospital intravenous calcium supplemental therapy (non-treatment) and patients who were treated with 10 mL of intravenous calcium chloride (10%) concurrently with blood products (treatment).

Results The study included 297 patients; 237 did not receive calcium and 60 did. The incidence of hypocalcaemia in the non-treatment group was 70.0% (n=166) compared with 28.3% (n=17) in the treatment group. Serum calcium levels were significantly different between the groups (1.03 mmol/L vs 1.25 mmol/L, difference 0.22 mmol/L, 95% CI 0.15 to 0.27). In the non-treatment group, 26.6% (n=63) had calcium levels within the normal range compared with 41.7% (n=25) in those who received calcium. There was a dose response of calcium level to blood products with a significant decrease in calcium levels as the volume of blood products increased.

Conclusion Trauma patients who received blood products were at high risk of hypocalcaemia. Aggressive management of these patients with intravenous calcium during transfusion may be required.

  • military
  • major trauma management
  • prehospital care

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  • Contributors The following individuals have contributed to the article: TK—contributed on all aspects of the article including literature search and review, data collection, data analysis and write-up, and is the guarantor for the overall content of the manuscript. IG—contributed to writing the initial and subsequent versions of the manuscript. AB—contributed to data collection and writing the manuscript. VW—statistician involved in all elements of statistical analysis. MB—biomedical scientist involved in writing initial and subsequent versions of the manuscript. JS—research adviser involved in project supervision, writing and editing the manuscript.

  • Competing interests None declared.

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

  • Data sharing statement Additional unpublished data from the study are only available to the research team and are stored on a password-protected computer.