Initial hematocrit in trauma: A paradigm shift?

Mark L. Ryan, Chad M. Thorson, Christian A. Otero, Thai Vu, Carl I Schulman, Alan Livingstone, Kenneth G Proctor

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

BACKGROUND: After severe trauma and hemorrhage, it is generally assumed that the rate of fluid shift from the interstitial space into the vasculature is relatively slow and that initial hematocrit (Hct) does not reflect estimated blood loss. This study challenges that idea and tests the hypothesis that initial Hct correlates with signs of shock and hemorrhage in trauma patients. METHODS: Data were retrospectively reviewed from 198 trauma patients requiring emergency surgery at a Level I center from July 2009 to April 2010. Patients were divided into quartiles based on the initial Hct measured within 10 minutes of arrival. Categorical data were compared using <2 test or Fisher's exact test, as appropriate. Normally distributed data were compared using Student's t test or analysis of variance. Nonparametric data were compared with a Mann-Whitney U test or Kruskal-Wallis test. Post hoc analysis was conducted using the Bonferroni correction or paired Mann-Whitney U tests. RESULTS: The study population was 83%male, aged 35 = 1 years (mean = SE), with 71%penetrating injuries. Lower initial Hct correlated with hypotension (p < 0.001), acidosis (p = 0.003), altered mental status (p < 0.001), Injury Severity Score (p < 0.001), Revised Trauma Score (p < 0.001), estimated blood loss (p < 0.001), and usage of packed red blood cells (p < 0.001), fresh frozen plasma (p = 0.003), crystalloid (p = 0.021), and vasopressors (p < 0.001). CONCLUSION: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.

Original languageEnglish
Pages (from-to)54-60
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume72
Issue number1
DOIs
StatePublished - Jan 1 2012

Fingerprint

Hematocrit
Wounds and Injuries
Fluid Shifts
Hemorrhage
Nonparametric Statistics
Shock
Emergencies
Injury Severity Score
Textbooks
Acidosis
Hypotension
Analysis of Variance
Teaching
Erythrocytes
Students
Population

Keywords

  • Estimated blood loss
  • Fluid resuscitation
  • Hemorrhage

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery
  • Medicine(all)

Cite this

Initial hematocrit in trauma : A paradigm shift? / Ryan, Mark L.; Thorson, Chad M.; Otero, Christian A.; Vu, Thai; Schulman, Carl I; Livingstone, Alan; Proctor, Kenneth G.

In: Journal of Trauma and Acute Care Surgery, Vol. 72, No. 1, 01.01.2012, p. 54-60.

Research output: Contribution to journalArticle

Ryan, Mark L. ; Thorson, Chad M. ; Otero, Christian A. ; Vu, Thai ; Schulman, Carl I ; Livingstone, Alan ; Proctor, Kenneth G. / Initial hematocrit in trauma : A paradigm shift?. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 72, No. 1. pp. 54-60.
@article{e9230561eab44cd0a2c5efd768139b06,
title = "Initial hematocrit in trauma: A paradigm shift?",
abstract = "BACKGROUND: After severe trauma and hemorrhage, it is generally assumed that the rate of fluid shift from the interstitial space into the vasculature is relatively slow and that initial hematocrit (Hct) does not reflect estimated blood loss. This study challenges that idea and tests the hypothesis that initial Hct correlates with signs of shock and hemorrhage in trauma patients. METHODS: Data were retrospectively reviewed from 198 trauma patients requiring emergency surgery at a Level I center from July 2009 to April 2010. Patients were divided into quartiles based on the initial Hct measured within 10 minutes of arrival. Categorical data were compared using <2 test or Fisher's exact test, as appropriate. Normally distributed data were compared using Student's t test or analysis of variance. Nonparametric data were compared with a Mann-Whitney U test or Kruskal-Wallis test. Post hoc analysis was conducted using the Bonferroni correction or paired Mann-Whitney U tests. RESULTS: The study population was 83{\%}male, aged 35 = 1 years (mean = SE), with 71{\%}penetrating injuries. Lower initial Hct correlated with hypotension (p < 0.001), acidosis (p = 0.003), altered mental status (p < 0.001), Injury Severity Score (p < 0.001), Revised Trauma Score (p < 0.001), estimated blood loss (p < 0.001), and usage of packed red blood cells (p < 0.001), fresh frozen plasma (p = 0.003), crystalloid (p = 0.021), and vasopressors (p < 0.001). CONCLUSION: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.",
keywords = "Estimated blood loss, Fluid resuscitation, Hemorrhage",
author = "Ryan, {Mark L.} and Thorson, {Chad M.} and Otero, {Christian A.} and Thai Vu and Schulman, {Carl I} and Alan Livingstone and Proctor, {Kenneth G}",
year = "2012",
month = "1",
day = "1",
doi = "10.1097/TA.0b013e31823d0f35",
language = "English",
volume = "72",
pages = "54--60",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Initial hematocrit in trauma

T2 - A paradigm shift?

AU - Ryan, Mark L.

AU - Thorson, Chad M.

AU - Otero, Christian A.

AU - Vu, Thai

AU - Schulman, Carl I

AU - Livingstone, Alan

AU - Proctor, Kenneth G

PY - 2012/1/1

Y1 - 2012/1/1

N2 - BACKGROUND: After severe trauma and hemorrhage, it is generally assumed that the rate of fluid shift from the interstitial space into the vasculature is relatively slow and that initial hematocrit (Hct) does not reflect estimated blood loss. This study challenges that idea and tests the hypothesis that initial Hct correlates with signs of shock and hemorrhage in trauma patients. METHODS: Data were retrospectively reviewed from 198 trauma patients requiring emergency surgery at a Level I center from July 2009 to April 2010. Patients were divided into quartiles based on the initial Hct measured within 10 minutes of arrival. Categorical data were compared using <2 test or Fisher's exact test, as appropriate. Normally distributed data were compared using Student's t test or analysis of variance. Nonparametric data were compared with a Mann-Whitney U test or Kruskal-Wallis test. Post hoc analysis was conducted using the Bonferroni correction or paired Mann-Whitney U tests. RESULTS: The study population was 83%male, aged 35 = 1 years (mean = SE), with 71%penetrating injuries. Lower initial Hct correlated with hypotension (p < 0.001), acidosis (p = 0.003), altered mental status (p < 0.001), Injury Severity Score (p < 0.001), Revised Trauma Score (p < 0.001), estimated blood loss (p < 0.001), and usage of packed red blood cells (p < 0.001), fresh frozen plasma (p = 0.003), crystalloid (p = 0.021), and vasopressors (p < 0.001). CONCLUSION: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.

AB - BACKGROUND: After severe trauma and hemorrhage, it is generally assumed that the rate of fluid shift from the interstitial space into the vasculature is relatively slow and that initial hematocrit (Hct) does not reflect estimated blood loss. This study challenges that idea and tests the hypothesis that initial Hct correlates with signs of shock and hemorrhage in trauma patients. METHODS: Data were retrospectively reviewed from 198 trauma patients requiring emergency surgery at a Level I center from July 2009 to April 2010. Patients were divided into quartiles based on the initial Hct measured within 10 minutes of arrival. Categorical data were compared using <2 test or Fisher's exact test, as appropriate. Normally distributed data were compared using Student's t test or analysis of variance. Nonparametric data were compared with a Mann-Whitney U test or Kruskal-Wallis test. Post hoc analysis was conducted using the Bonferroni correction or paired Mann-Whitney U tests. RESULTS: The study population was 83%male, aged 35 = 1 years (mean = SE), with 71%penetrating injuries. Lower initial Hct correlated with hypotension (p < 0.001), acidosis (p = 0.003), altered mental status (p < 0.001), Injury Severity Score (p < 0.001), Revised Trauma Score (p < 0.001), estimated blood loss (p < 0.001), and usage of packed red blood cells (p < 0.001), fresh frozen plasma (p = 0.003), crystalloid (p = 0.021), and vasopressors (p < 0.001). CONCLUSION: Admission Hct correlates with signs of shock and hemorrhage in trauma patients requiring emergency surgery because fluid shifts rapidly from the interstitial space into the vasculature. This finding of a rapid Hct change contradicts the current teaching in most trauma textbooks.

KW - Estimated blood loss

KW - Fluid resuscitation

KW - Hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=84859647769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84859647769&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e31823d0f35

DO - 10.1097/TA.0b013e31823d0f35

M3 - Article

C2 - 22310116

AN - SCOPUS:84859647769

VL - 72

SP - 54

EP - 60

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 1

ER -