Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention

Jonathan Parks, Georgia Vasileiou, Joshua Parreco, Gerd D. Pust, R. Rattan, T. Zakrison, Nicholas Namias, D. Dante Yeh

Research output: Contribution to journalArticle

Abstract

Background: The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. Materials and methods: We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. Results: 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. Conclusions: Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.

Original languageEnglish (US)
Pages (from-to)163-167
Number of pages5
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

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Advanced Trauma Life Support Care
Shock
Wounds and Injuries
Blood Transfusion
Mortality
Life Support Systems
Aptitude
Vital Signs

ASJC Scopus subject areas

  • Surgery

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Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention. / Parks, Jonathan; Vasileiou, Georgia; Parreco, Joshua; Pust, Gerd D.; Rattan, R.; Zakrison, T.; Namias, Nicholas; Yeh, D. Dante.

In: Journal of Surgical Research, Vol. 245, 01.01.2020, p. 163-167.

Research output: Contribution to journalArticle

Parks, Jonathan ; Vasileiou, Georgia ; Parreco, Joshua ; Pust, Gerd D. ; Rattan, R. ; Zakrison, T. ; Namias, Nicholas ; Yeh, D. Dante. / Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention. In: Journal of Surgical Research. 2020 ; Vol. 245. pp. 163-167.
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abstract = "Background: The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. Materials and methods: We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. Results: 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9{\%}), 3123 (1.0{\%}) were transfused blood products, and 7115 (2.3{\%}) underwent an urgent procedure. In class 2, 219 (1.3{\%}) died, 387 (2.3{\%}) were transfused, and 1575 (9.2{\%}) underwent intervention. In class 3, 7 (22.6{\%}) died, 10 (32.3{\%}) were transfused, and 13 (41.9{\%}) underwent intervention. In class 4, 15 (34.9{\%}) died, 19 (44.2{\%}) were transfused, and 23 (53.5{\%}) underwent intervention. For uncategorized patients, 21,356 (7.1{\%}) died, 15,168 (5.0{\%}) were transfused, and 23,844 (7.9{\%}) underwent intervention. Conclusions: Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1{\%}) than patients in classes 1 and 2 (0.9{\%} and 1.3{\%}, respectively). Classes 3 and 4 only accounted for 0.005{\%} and 0.007{\%}, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.",
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AU - Vasileiou, Georgia

AU - Parreco, Joshua

AU - Pust, Gerd D.

AU - Rattan, R.

AU - Zakrison, T.

AU - Namias, Nicholas

AU - Yeh, D. Dante

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