RT Journal Article
SR Electronic
T1 Pilot study of the prevalence, outcomes and detection of occult hypoperfusion in trauma patients
JF Emergency Medicine Journal
JO Emerg Med J
FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine
SP 470
OP 472
DO 10.1136/emj.2009.073254
VO 27
IS 6
A1 Ogilvie Thom
A1 David McD Taylor
A1 Rachel E Wolfe
A1 Paul Myles
A1 Henry Krum
A1 Rory Wolfe
YR 2010
UL http://emj.bmj.com/content/27/6/470.abstract
AB 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.