| Title |
Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®
|
|---|---|
| Published in |
Critical Care, March 2013
|
| DOI | 10.1186/cc12555 |
| Pubmed ID | |
| Authors |
Manuel Mutschler, Ulrike Nienaber, Thomas Brockamp, Arasch Wafaisade, Tobias Fabian, Thomas Paffrath, Bertil Bouillon, Marc Maegele, the TraumaRegister DGU |
| Abstract |
INTRODUCTION: The recognition and management of hypovolemic shock still remain an important task during initial trauma assessment. Recently, we have questioned the validity of the Advanced Trauma Life Support (ATLS) classification of hypovolemic shock by demonstrating that the suggested combination of heart rate, systolic blood pressure and Glasgow Coma Scale displays substantial deficits in reflecting clinical reality. The aim of this study was to introduce and validate a new classification of hypovolemic shock based upon base deficit (BD) at emergency department (ED) arrival. METHODS: Between 2002 and 2010, 16,305 patients were retrieved from the TraumaRegister DGU® database, classified into four strata of worsening BD [class I (BD ≤ 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class IV (BD > 10 mmol/l)] and assessed for demographics, injury characteristics, transfusion requirements and fluid resuscitation. This new BD-based classification was validated to the current ATLS classification of hypovolemic shock. RESULTS: With worsening of BD, injury severity score (ISS) increased in a step-wise pattern from 19.1 (± 11.9) in class I to 36.7 (± 17.6) in class IV, while mortality increased in parallel from 7.4% to 51.5%. Decreasing hemoglobin and prothrombin ratios as well as the amount of transfusions and fluid resuscitation paralleled the increasing frequency of hypovolemic shock within the four classes. The number of blood units transfused increased from 1.5 (± 5.9) in class I patients to 20.3 (± 27.3) in class IV patients. Massive transfusion rates increased from 5% in class I to 52% in class IV. The new introduced BD-based classification of hypovolemic shock discriminated transfusion requirements, massive transfusion and mortality rates significantly better compared to the conventional ATLS classification of hypovolemic shock (p < 0.001). CONCLUSIONS: BD may be superior to the current ATLS classification of hypovolemic shock in identifying the presence of hypovolemic shock and in risk stratifying patients in need of early blood product transfusion. |
X Demographics
The data shown below were collected from the profiles of 37 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 7 | 19% |
| Mexico | 2 | 5% |
| United States | 2 | 5% |
| Australia | 2 | 5% |
| Canada | 2 | 5% |
| Saudi Arabia | 1 | 3% |
| Greece | 1 | 3% |
| Japan | 1 | 3% |
| Spain | 1 | 3% |
| Other | 4 | 11% |
| Unknown | 14 | 38% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 18 | 49% |
| Practitioners (doctors, other healthcare professionals) | 15 | 41% |
| Science communicators (journalists, bloggers, editors) | 3 | 8% |
| Scientists | 1 | 3% |
Mendeley readers
The data shown below were compiled from readership statistics for 287 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Brazil | 2 | <1% |
| Mexico | 2 | <1% |
| France | 1 | <1% |
| India | 1 | <1% |
| Ecuador | 1 | <1% |
| United Kingdom | 1 | <1% |
| Spain | 1 | <1% |
| Unknown | 278 | 97% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Postgraduate | 42 | 15% |
| Other | 33 | 11% |
| Student > Bachelor | 32 | 11% |
| Researcher | 31 | 11% |
| Student > Master | 31 | 11% |
| Other | 71 | 25% |
| Unknown | 47 | 16% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 204 | 71% |
| Nursing and Health Professions | 13 | 5% |
| Agricultural and Biological Sciences | 3 | 1% |
| Pharmacology, Toxicology and Pharmaceutical Science | 2 | <1% |
| Environmental Science | 2 | <1% |
| Other | 9 | 3% |
| Unknown | 54 | 19% |
Attention Score in Context
This research output has an Altmetric Attention Score of 27. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 February 2022.
All research outputs
#1,447,232
of 25,713,737 outputs
Outputs from Critical Care
#1,250
of 6,603 outputs
Outputs of similar age
#10,812
of 208,690 outputs
Outputs of similar age from Critical Care
#12
of 174 outputs
Altmetric has tracked 25,713,737 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 6,603 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 20.8. This one has done well, scoring higher than 81% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 208,690 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 94% of its contemporaries.
We're also able to compare this research output to 174 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 93% of its contemporaries.