Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patientsReportar como inadecuado

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BMC Surgery

, 4:3

First Online: 19 January 2004Received: 29 April 2003Accepted: 19 January 2004


BackgroundWe sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis increased base deficit and lactate, and impaired pulmonary physiology decreased spirometric volume and PaO2-FiO2.

MethodsLevel I trauma center prospective pilot and post-pilot study 2000–2001 of stable patients. Increased base deficit was < 0.0 in ethanol-negative and ≤ -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol-L in ethanol-negative and ≥ 3.0 mmol-L in ethanol-positive patients. Decreased PaO2-FiO2 was < 350 and decreased spirometric volume was < 1.8 L.

ResultsOf 215 patients, 66 30.7% had a torso injury abdominal-pelvic injury n = 35 and-or thoracic injury n = 43. Glasgow Coma Scale score was 14.8 ± 0.5 13–15. Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO2-FiO2, and spirometric volume – 0.0% and 0.0%; normal base deficit and normal spirometric volume – 4.2% and 4.5%; chest-abdominal soft tissue injury – 37.8% and 47.0%; increased lactate – 39.7% and 47.0%; increased base deficit – 41.3% and 75.8%; increased base deficit and-or decreased spirometric volume – 43.8% and 95.5%; decreased PaO2-FiO2 – 48.9% and 33.3%; positive abdominal ultrasound – 62.5% and 7.6%; decreased spirometric volume – 73.4% and 71.2%; increased base deficit and decreased spirometric volume – 82.9% and 51.5%.

ConclusionsTrauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2-FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and-or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.

AbbreviationsABGarterial blood gas

ATLSAdvanced Trauma Life Support

BDbase deficit

CTcomputed tomography

DPLdiagnostic peritoneal lavage

FASTfocused abdominal sonography for trauma

ISSInjury Severity Score

LUQleft upper quadrant

RUQright upper quadrant

SVspirometric volume

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Autor: C Michael Dunham - Eilynn K Sipe - LeeAnn Peluso

Fuente: https://link.springer.com/article/10.1186/1471-2482-4-3

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