• Acad Emerg Med · Dec 2006

    Effect of normal saline infusion on the diagnostic utility of base deficit in identifying major injury in trauma patients.

    • Richard Sinert, Shahriar Zehtabchi, Christina Bloem, and Michael Lucchesi.
    • Department of Emergency Medicine, State University of New York, Downstate Medical Center-Kings County Hospital Center, New York, NY, USA. nephron1@bellatlantic.net
    • Acad Emerg Med. 2006 Dec 1;13(12):1269-74.

    BackgroundBase deficit (BD) is a reliable marker of metabolic acidosis and is useful in gauging hemorrhage after trauma. Resuscitation with chloride-rich solutions such as normal saline (NS) can cause a dilutional acidosis, possibly confounding the interpretation of BD.ObjectivesTo test the diagnostic utility of BD in distinguishing minor from major injury after administration of NS.MethodsThis was a prospective observational study at a Level 1 trauma center. The authors enrolled patients with significant mechanism of injury and measured BD at triage (BD-0) and at four hours after triage (BD-4). Major injury was defined by any of the following: injury severity score of > or =15, drop in hematocrit of > or = 10 points, or the patient requiring a blood transfusion. Patients were divided into a low-volume (NS < 2L) and a high-volume (NS 2L) group. Data were reported as mean (+/-SD). Student's t- and Wilcoxon tests were used to compare data. Receiver operating characteristic (ROC) curves tested the utility of BD-4 in differentiating minor from major injury in the study groups.ResultsFour hundred eighty-nine trauma patients (mean age, 36 [+/-18] yr) were enrolled; 82% were male, and 34% had penetrating injury. Major-(20%) compared with minor-(80%) injury patients were significantly (p = 0.0001) more acidotic (BD-0 mean difference: -3.3 mmol/L; 95% confidence interval [CI] = -2.5 to -4.2). The high-volume group (n = 174) received 3,342 (+/-1,821) mL, and the low-volume group (n = 315) received 621 (+/-509) mL of NS. Areas under the ROC curves for the high-volume (0.63; 95% CI = 0.52 to 0.74) and low-volume (0.73; 95% CI = 0.60 to 0.86) groups were not significantly different from each other.ConclusionsBase deficit was able to distinguish minor from major injury after four hours of resuscitation, irrespective of the volume of NS infused.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…