Hemodynamic reactions in patients with hemorrhagic shock from blunt trauma after initial fluid therapy.

OBJECT: This study sought to define hemorrhagic shock from blood pressure and heart rate and then to provide a treatment policy based on response to initial fluid therapy.

MATERIALS: This was a prospective clinical observational study conducted in eight hospitals. Subjects were consecutive patients with trauma who met any of the field triage conditions proposed by the Committee on Trauma of the American College of Surgeons. Initial fluid therapy was performed in patients with suspected hemorrhagic shock. Patients who required blood transfusion ≥ 4 U within 24 hours or interventions for active bleeding within 24 hours were classified into a "bleeding group" (B). A "nonbleeding group" (non-B) comprised patients who did not require blood transfusion ≥ 4 U or other interventions within 24 hours. Our committee maintained the database of survey items. Four of the hospitals were selected at random to provide training data and that was used in a recursive partitioning analysis to predict the B group. Data on patients in the other four facilities were used for validation.

RESULTS

There were a total of 400 patients studied. The training set consisted of 261 patients, 50 of whom were classified into the B group. A total of 94% patients with hemorrhagic shock suspected clinically, shock index at admission (first SI) ≥ 0.8, and SI at 1 L of fluid resuscitation (second SI) ≥ 1.0 were assigned to the B group. The non-B group (92%) were patients those whose first SI was < 0.8 and base deficits at admission ≥ -1.0. Validation data consisted of 139 patients. The sensitivity, specificity, and accuracy of these data to predict the B group were 71%, 93%, and 89%, respectively.

CONCLUSIONS

Patients whose first SI was ≥ 0.8 and second SI ≥ 1.0 would be diagnosed as "nonresponders" by American College of Surgeons. Patients with first SI < 0.8 and base deficits ≥ -1.0 will not be candidates for the B group.