Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members

Abstract

IntroductionTrauma is a great contributor to mortality worldwide. One of the challenges in trauma care is early identification and management of bleeding. The circulatory status of blunt trauma patients in the emergency room is evaluated using hemodynamic (HD) parameters. However, there is no consensus on which parameters to use. In this study, we evaluate the used terms and definitions in the literature for HD stability and compare those to the opinion of Dutch trauma team members.MethodA systematic review was performed to collect the definitions used for HD stability. Studies describing the assessment and/or treatment of blunt trauma patients in the emergency room were included. In addition, an online survey was conducted amongst Dutch trauma team members.ResultsOut of a total of 222, 67 articles were found to be eligible for inclusion. HD stability was defined in 70% of these articles. The most used parameters were systolic blood pressure and heart rate. Besides the variety of parameters, a broad range of corresponding cut-off points is noted. Despite some common ground, high inter- and intra-variability is seen for the physicians that are part of the Dutch trauma teams.ConclusionAll authors acknowledge HD stability as the most important factor in the assessment and management of blunt trauma patients. There is, however, no consensus in the literature as well as none-to-fair consensus amongst Dutch trauma team members in the definition of HD stability. A trauma team ready to co-operate with consensus-based opinions together with a valid scoring system is in our opinion the best method to assess and treat seriously injured trauma patients.

Missions of the Helicopter Emergency Medical Service in rural and urban areas in Poland – A comparative retrospective analysis

“…Each parameter is evaluated on a scale of 0-4 points, the maximum number of points is 12 and the minimum -0 points. A score below 4 means that the patients should be treated in a trauma centre [16].…”

TRIAGE : Management of the trauma patient

“…Bleeding has been shown to be the leading cause of preventable deaths among trauma patients [94]. In this context, identification and timely management of hemorrhage to minimize the time between injury and intervention is essential [95]. A classification of estimated blood loss based on clinical signs is used in the ATLS curriculum [89].…”

“…To identify hemorrhagic shock in a trauma patient only assessing vital signs is demanding, and the associated difficulties have been discussed [95]. When an MCI occurs and several patients are traumatized with similar conditions, in combination with a general lack of resources, the situation becomes even more demanding.…”

Management of pediatric blunt abdominal trauma in a Dutch level one trauma center

“…The research team scored a patient as hemodynamic unstable if hemodynamic instability was noted in the electronic patient registry by the trauma surgeon on duty. The most used parameters to assess hemodynamic instability are both SBP < 80-100 and HR > 100-120 [6]. In the case of hemodynamic instability, the mass transfusion protocol was always started using the ratio one package red blood cells on one package fresh frozen plasma on one package platelets.…”

“…A better understanding of the natural history of intraabdominal injuries now allows for less aggressive treatment options and more selective operative interventions [5]. A laparotomy is only required in case of a perforating hollow viscus injury or in case of solid organ injury and hemodynamic instability despite adequate resuscitation [6]. In other cases, children with solid organ injuries are generally managed non-operatively [2].…”