Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation

Chad M. Thorson, Mark L. Ryan, Robert M. Van Haren, Reginald Pereira, Jeremy Olloqui, Christian A. Otero, Carl I Schulman, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

This study tests the hypothesis that a change in hematocrit (ΔHct) during initial trauma work-up is as reliable as conventional vital signs for detecting bleeding, even with ongoing fluid resuscitation. Consecutive trauma patients admitted to a Level I trauma center receiving two Hct measurements during initial resuscitation between January 2010 and January 2011 were stratified based on estimated blood loss greater than 250 mL (bleeding) or nonbleeding. Sensitivity, specificity, and receiver operating characteristic curves were calculated for systolic blood pressure (SBP), heart rate, base deficit, and ΔHct. In 168 (72%) nonbleeding versus 64 (28%) bleeding patients, age and gender were similar. Arrival SBP was highly specific (90 to 99%) but poorly sensitive (13 to 31%) for detecting bleeding. Combinations of vital signs increased specificity, albeit at the expense of sensitivity. For bleeding versus nonbleeding patients (all receiving resuscitation fluid), ΔHct was 9.0 versus 1.8, ΔHct/liter was 4.8 versus 1.5, and ΔHct/liter/hour was 2.8 vs 0.6 (all P < 0.001). Only SBP (area under the curve [AUC] 0.608 to 0.695) and ΔHct (AUC 0.731 to 0.921) were significant for identifying bleeding with ΔHct 6 or greater being the best predictor (sensitivity 89%, specificity 95%, AUC 0.921). During ongoing fluid resuscitation of a trauma victim, ΔHct is the single most reliable indicator of continuing blood loss. A ΔHct 6 or greater during initial resuscitation is highly suspicious for ongoing blood loss, but even lesser changes have predictive value. Altogether, these results support the idea that fluid shifts are rapid after hemorrhage and Hct can be valuable during initial trauma assessment.

Original languageEnglish
Pages (from-to)398-406
Number of pages9
JournalAmerican Surgeon
Volume79
Issue number4
StatePublished - Apr 1 2013

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Hematocrit
Resuscitation
Hemorrhage
Wounds and Injuries
Blood Pressure
Area Under Curve
Vital Signs
Fluid Shifts
Sensitivity and Specificity
Trauma Centers
ROC Curve
Heart Rate

ASJC Scopus subject areas

  • Surgery

Cite this

Thorson, C. M., Ryan, M. L., Van Haren, R. M., Pereira, R., Olloqui, J., Otero, C. A., ... Proctor, K. G. (2013). Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation. American Surgeon, 79(4), 398-406.

Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation. / Thorson, Chad M.; Ryan, Mark L.; Van Haren, Robert M.; Pereira, Reginald; Olloqui, Jeremy; Otero, Christian A.; Schulman, Carl I; Livingstone, Alan; Proctor, Kenneth G.

In: American Surgeon, Vol. 79, No. 4, 01.04.2013, p. 398-406.

Research output: Contribution to journalArticle

Thorson, CM, Ryan, ML, Van Haren, RM, Pereira, R, Olloqui, J, Otero, CA, Schulman, CI, Livingstone, A & Proctor, KG 2013, 'Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation', American Surgeon, vol. 79, no. 4, pp. 398-406.
Thorson CM, Ryan ML, Van Haren RM, Pereira R, Olloqui J, Otero CA et al. Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation. American Surgeon. 2013 Apr 1;79(4):398-406.
Thorson, Chad M. ; Ryan, Mark L. ; Van Haren, Robert M. ; Pereira, Reginald ; Olloqui, Jeremy ; Otero, Christian A. ; Schulman, Carl I ; Livingstone, Alan ; Proctor, Kenneth G. / Change in hematocrit during trauma assessment predicts bleeding even with ongoing fluid resuscitation. In: American Surgeon. 2013 ; Vol. 79, No. 4. pp. 398-406.
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abstract = "This study tests the hypothesis that a change in hematocrit (ΔHct) during initial trauma work-up is as reliable as conventional vital signs for detecting bleeding, even with ongoing fluid resuscitation. Consecutive trauma patients admitted to a Level I trauma center receiving two Hct measurements during initial resuscitation between January 2010 and January 2011 were stratified based on estimated blood loss greater than 250 mL (bleeding) or nonbleeding. Sensitivity, specificity, and receiver operating characteristic curves were calculated for systolic blood pressure (SBP), heart rate, base deficit, and ΔHct. In 168 (72{\%}) nonbleeding versus 64 (28{\%}) bleeding patients, age and gender were similar. Arrival SBP was highly specific (90 to 99{\%}) but poorly sensitive (13 to 31{\%}) for detecting bleeding. Combinations of vital signs increased specificity, albeit at the expense of sensitivity. For bleeding versus nonbleeding patients (all receiving resuscitation fluid), ΔHct was 9.0 versus 1.8, ΔHct/liter was 4.8 versus 1.5, and ΔHct/liter/hour was 2.8 vs 0.6 (all P < 0.001). Only SBP (area under the curve [AUC] 0.608 to 0.695) and ΔHct (AUC 0.731 to 0.921) were significant for identifying bleeding with ΔHct 6 or greater being the best predictor (sensitivity 89{\%}, specificity 95{\%}, AUC 0.921). During ongoing fluid resuscitation of a trauma victim, ΔHct is the single most reliable indicator of continuing blood loss. A ΔHct 6 or greater during initial resuscitation is highly suspicious for ongoing blood loss, but even lesser changes have predictive value. Altogether, these results support the idea that fluid shifts are rapid after hemorrhage and Hct can be valuable during initial trauma assessment.",
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