Hypocalcemia in trauma patients: A systematic review

Vasudeva, Mayank; Mathew, Joseph; Groombridge, Christopher J.; Tee, Jin; Johnny, Cecil S.; Maini, Amit; Fitzgerald, Mark

doi:10.1097/ta.0000000000003027

Cited by 46 publications

(74 citation statements)

References 44 publications

(17 reference statements)

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“…15 In concordance with previous studies, severe hypocalcemia was defined as Ca ++ < 1.0 mmol/L and mild hypocalcemia as 1.0 mmol/L ≤ Ca ++ < 1.1 mmol/L. 6 We extracted demographic data (age and gender); mechanism of injury (blunt vs. penetrating); vital signs at admission (Glasgow Coma Scale [GCS], heart rate, SBP, and pediatric age-adjusted shock index 16 ); the presence of isolated head injury-abbreviated injury score (AIS) for the head ≥ 4 and an extra-cranial AIS < 2; laboratory parameters at admission (pH, lactate, bicarbonate, partial prothrombin time [PTT], international normalized ratio [INR], hemoglobin, platelets count); and clinical course (pediatric intensive care [PICU] admission, PICU length of stay [LOS], hospital LOS, blood transfusion in the emergency department [ED], and in-hospital mortality). The primary outcome of this study was urgent blood transfusion, defined as a blood transfusion performed in the ED.…”

Section: Data Collection and Definitionssupporting

confidence: 57%

“…It is caused by loss of calcium during hemorrhage, intracellular flux secondary to ischemia and reperfusion, impaired calcium homeostasis, and increased sympathetic activity. Citrate‐containing blood products aggravate hypocalcemia during resuscitation 6 . Studies found that 23%–56% of severely injured adult trauma patients have ionized calcium (Ca ++ ) < 1.0 mmol/L on admission, before any blood transfusion 7,8 .…”

Section: Introductionmentioning

confidence: 99%

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Admission hypocalcemia in pediatric major trauma patients—An uncommon phenomenon associated with an increased need for urgent blood transfusion

et al. 2022

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Background Hemorrhage is a leading cause of death among children. Recent data from adult trauma suggests that early, transfusion‐unrelated, hypocalcemia is common and that it is associated with an increased need for blood transfusion, mortality, and coagulopathy. The objectives of this study are to evaluate the prevalence of admission hypocalcemia in severely injured children and its correlation with urgent blood transfusion. Study Design and Methods This is a retrospective cohort study of all severely injured (Injury Severity Score [ISS] > 15) pediatric (<18 years) trauma patients admitted to Rambam Health Care Campus, Israel between 2012 and 2020. We excluded patients transferred from other facilities and those who received blood before determining calcium levels. Severe hypocalcemia was defined as ionized calcium (Ca++) < 1.0 mmol/L and mild hypocalcemia as 1.0 mmol/L ≤ Ca++ < 1.1 mmol/L. The primary outcome was urgent blood transfusion (transfusion in the emergency department [ED]). Results Six hundred seventy‐three severely injured children were admitted from the field. Ca++ levels were determined before blood transfusion in 457 patients. Severe hypocalcemia was found in three patients (0.7%) and mild hypocalcemia in additional 21 patients (4.6%). Hypocalcemic patients required more urgent blood transfusion (29.2% vs. 6.5%, p < .001) and had higher ISS (29 [interquartile range, IQR: 22–35] vs. 25 [IQR: 19–34], p = .05). Multivariable logistic regression analysis identified Ca++ < 1.1 mmol/L as an independent predictor of the need for blood transfusion, odds ratio 5.44 (95% confidence interval 1.44–20.58), p = .01. Discussion Contrary to adults, admission hypocalcemia is uncommon in severely injured children. However, it may be associated with an increased risk of blood transfusion in the ED.

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Section: Data Collection and Definitionssupporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Admission hypocalcemia in pediatric major trauma patients—An uncommon phenomenon associated with an increased need for urgent blood transfusion

et al. 2022

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“…Wang et al (9) demonstrated that for critically ill patients, tCa showed no independent association with mortality, while low iCa levels were important prognosis predictors. In a systematic review investigating hypocalcemia in trauma patients, low iCa at admission was found to be related to elevated mortality (10). Moreover, a retrospective study including 357 pediatric patients established that high iCa level was independently associated with longer ICU stay in pediatric PCS patients (11).…”

Section: Introductionmentioning

confidence: 99%

The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

Liu

et al. 2021

Front. Cardiovasc. Med.

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Background: Present researches exploring the prognostic value of calcium concentration are undermined by sample size and study design. Our study investigated the association of both total calcium (tCa) and ionized Ca (iCa) to short- and long-term mortality and other outcomes in post-cardiovascular surgery (PCS) patients admitted to intensive care unit (ICU) from two large public data sets.Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) database and the eICU Collaborative Research Database (eICU) were inspected to identify PCS patients. The primary outcome was 28-day mortality. Multivariate regression was used to elucidate the relationship between calcium concentration and outcomes. The propensity score estimation was performed to validate our findings.Results: A total of 6122 and 914 patients were included from the MIMIC III and eICU data sets, respectively. The groups with the most patients were the mild hypo-iCa and hypo-tCa groups. The mild hypo-iCa group showed significant association with worse short-term and long-term prognosis, less use of ventilation, longer ICU and hospital stay, and more incidence of 7-day acute kidney injury.Conclusions: The mild hypo-iCa (0.9–1.15 mmol/L) within the first day of admission to the ICU could serve as an independent prognosis factor for PCS patients.

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“…Similarly, almost 27.72% of hospital patients may experience hypocalcemia, and the incidence was the highest in patients over 65 years [ 31 ]. Regarding the harm of hypocalcemia, a recent review summarized the relationships between preoperative hypocalcemia and postoperative adverse complications in elderly patients [ 32 ], and another systematic review found admission hypocalcemia was associated with increased mortality in trauma patients [ 18 ]. These findings suggest that clinicians should pay attention to hypocalcemia because of life-threatening consequence [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Serum calcium as the coagulation factor IV, participates in the regulation of coagulation cascade [ 17 ]. Hypocalcemia is a common electrolyte disorder in hospitalized patients, nearly 56.2% in trauma patients [ 18 ]. Many studies have already investigated its harmful effect, and found that hypocalcemia was associated with more bleeding or blood transfusion in patients with intracerebral hemorrhage [ 19 ], postpartum hemorrhage [ 20 ], upper gastrointestinal bleeding [ 21 ], shocked trauma [ 22 ], and total knee arthroplasty [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

Wang

Chen

et al. 2021

BMC Musculoskelet Disord

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Background To investigate whether hypocalcemia influenced total blood loss and transfusion rate in elderly patients with hip fracture. Methods From our hip fracture database, patients were consecutively included between January 2014 and December 2020. Serum calcium level was corrected for albumin concentration, and hypocalcaemia was defined as corrected calcium < 2.11 mmol/L. Hemoglobin and hematocrit were obtained on admission day and postoperative day, and blood transfusions were collected. According to the combination formulas of Nadler and Gross, the total blood loss of each patient was calculated. Risk factors were further analyzed by multivariate linear regression. Results A total of 583 consecutive elderly hip fracture patients were finally included (mean age 79.32 ± 8.18 years, 68.61% female). On admission, the mean serum corrected calcium level was 2.17 ± 0.14 mmol/L, and the prevalence of hypocalcemia was 33.11% (95% CI: 29.42–37.02). When comparing patients with normal calcium, hypocalcemia patients exhibited a higher blood transfusion rate (7.69% vs 16.06%, P < 0.05), and significantly larger total blood loss (607.86 ± 497.07 ml vs 719.18 ± 569.98 ml, P < 0.05). Multivariate linear regression analysis showed that male, anemia on admission, time from injury to hospital, intertrochanteric fracture, blood transfusion and hypocalcemia were independently associated with increased total blood loss (P < 0.05). Conclusion Hypocalcemia is common in elderly patients with hip fracture, and significantly associated with more total blood loss and blood transfusion. The other risk factors for increased total blood loss are male, anemia on admission, time from injury to hospital, intertrochanteric fracture, and blood transfusion. Level of evidence Level III, retrospective study.

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Hypocalcemia in trauma patients: A systematic review

Abstract: Supplemental digital content is available in the text.

Cited by 46 publications

References 44 publications

Admission hypocalcemia in pediatric major trauma patients—An uncommon phenomenon associated with an increased need for urgent blood transfusion

Admission hypocalcemia in pediatric major trauma patients—An uncommon phenomenon associated with an increased need for urgent blood transfusion

The Prognostic Value of Calcium in Post-Cardiovascular Surgery Patients in the Intensive Care Unit

Low serum calcium is associated with perioperative blood loss and transfusion rate in elderly patients with hip fracture: a retrospective study

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