Original contribution
Base deficit as an indicator of significant abdominal injury

https://doi.org/10.1016/S0196-0644(05)81423-4Get rights and content

Objective:

To determine the relative predictive value of the arterial base deficit (BD) as an indicator of intra-abdominal injury (Al) and to compare BD with other indicators (chest injuries, pelvic fractures) of Al.

Design:

Retrospective case-control analysis.

Setting:

University of California San Diego Medical Center.

Measurements and main results:

Between January 1985 and July 1988, 3, 223 blunt trauma patients were admitted, with complete records available on 3, 011. Using a “best fit” multiple logistic regression, BD ⩽ −6 was the single most important indicator of Al (P ⩽ .0001), and the odds ratio for Al increased with each category of increasing severity of BD. Admission hypotension, major chest injury, pelvic fracture, and field hypotension (in odds ratio order) also were significantly associated with Al.

Conclusion:

BD is a powerful indicator of Al. A normal BD does not exclude Al, but the presence of a BD ⩽ −6 in a blunt trauma patient should be considered a strong indication for objective evaluation of the abdomen (ie, diagnostic peritoneal lavage).

References (15)

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  • FAST for blunt abdominal trauma: Correlation between positive findings and admission acid-base measurement

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  • Is arterial base deficit still a useful prognostic marker in trauma? A systematic review

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    The earlier 2 studies by Mackersie et al [15] and Davis et al [16] had defined intraabdominal injuries as injuries requiring surgical repair, whereas the later study by Mofidi et al [2] defined intraabdominal injuries as the presence of free fluid on ultrasonography, computed tomographic scan, or laparotomy or 7-day follow-up for abdominal symptoms. In the earlier studies, the OR for intraabdominal injuries was 1.74 if BD was more than 3 mmol/L [15] and 1.8 if BD was more than 6 mmol/L [16]. For every unit increase in BD, the OR for intraabdominal injury also increased by 1.107 times [16].

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Presented at the Society for Academic Emergency Medicine Annual Meeting in Minneapolis, Minnesota, May 1990.

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