How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study

Abstract

BackgroundThe diagnostic value of hemoglobin (Hb) for detecting a significant hemorrhage (SH) in the early phase of trauma remains controversial. The present study aimed to assess the abilities of Hb measurements taken at different times throughout trauma management to identify patients with SH.MethodsAll consecutive adult trauma patients directly admitted to six French level-1 trauma centers with at least one prehospital Hb measurement were analyzed. The abilities of the following variables to identify SH (≥ 4 units of red blood cells in the first 6 h and/or death related to uncontrolled bleeding within 24 h) were determined and compared to that of shock index (SI): Hb as measured with a point-of-care (POC) device by the prehospital team on scene (POC-Hbprehosp) and upon patient’s admission to the hospital (POC-Hbhosp), the difference between POC-Hbhosp and POC-Hbprehosp (DeltaPOC-Hb) and Hb as measured by the hospital laboratory on admission (Hb-Labhosp).ResultsA total of 6402 patients were included, 755 with SH and 5647 controls (CL). POC-Hbprehosp significantly predicted SH with an area under ROC curve (AUC) of 0.72 and best cutoff values of 12 g/dl for women and 13 g/dl for men. POC-Hbprehosp < 12 g/dl had 90% specificity to predict of SH. POC-Hbhosp and Hb-Labhosp (AUCs of 0.92 and 0.89, respectively) predicted SH better than SI (AUC = 0.77, p < 0.001); best cutoff values of POC-Hbhosp were 10 g/dl for women and 12 g/dl for men. DeltaPOC-Hb also predicted SH with an AUC of 0.77, a best cutoff value of − 2 g/dl irrespective of the gender. For a same prehospital fluid volume infused, DeltaPOC-Hb was significantly larger in patients with significant hemorrhage than in controls.ConclusionsChallenging the classical idea that early Hb measurement is not meaningful in predicting SH, POC-Hbprehosp was able, albeit modestly, to predict significant hemorrhage. POC-Hbhosp had a greater ability to predict SH when compared to shock index. For a given prehospital fluid volume infused, the magnitude of the Hb drop was significantly higher in patients with significant hemorrhage than in controls.Electronic supplementary materialThe online version of this article (10.1186/s13613-018-0420-8) contains supplementary material, which is available to authorized users.

Direct transport vs secondary transfer to level I trauma centers in a French exclusive trauma system: Impact on mortality and determinants of triage on road-traffic victims

“…Available prehospital variables included the mechanism of accident and distance to TC (categorized in inner or outer region as in Fig 1), demographic variables (age and gender) and worst vital signs during prehospital phase among: minimal Glasgow Coma Scale (GCS), maximal heart rate (HR), minimal systolic arterial blood pressure (SAP), minimal peripheral oxygen saturation (SpO 2 ) [20], early on scene capillary hemoglobin concentration [21], MGAP score [19], tracheal intubation and vasopressor administration. The assessment of high speed was reported according to the Vittel criteria and the total number Vittel criteria was quantified [18].…”

Delta neutrophil index and shock index can stratify risk for the requirement for massive transfusion in patients with primary postpartum hemorrhage in the emergency department

“…Consequently, severe hemorrhage may contribute to the release of immature granulocytes into the circulation [24,28]. As pregnant women often have prenatal anemia, it is difficult to determine the occurrence of massive hemorrhage and evaluate the requirement for massive transfusion based on hemoglobin levels alone in patients with PPH [29]. Although lower hemoglobin or hematocrit levels have been widely and interchangeably used as indicators of severe bleeding, their diagnostic values for determining the severity of blood loss in the initial phase in patients with severe hemorrhage, such as trauma-related and GI bleeding, remain controversial [29].…”

Blunt Aortic Traumatic Injury Management: An Observational Study in 10 French Trauma Centers.

“…Patients with severe BTAI had severe hemorrhage predictive indicators (shock index, red ag). Despite patient's high risk of hemorrhage, the prehospital capillary hemoglobin was not decreased in accordance to the aortic grade whereas it has been described to be lower in patients with severe hemorrhage (15,16), this highlight that intensive bleeding might occur secondarily.…”