Serial hematocrit testing does not identify major injuries in trauma patients in an observation unit

Madsen, Troy; Dawson, Matthew; Bledsoe, Joseph; Bossart, Philip

doi:10.1016/j.ajem.2009.01.034

Cited by 3 publications

(3 citation statements)

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“…In a retrospective study of 404 trauma patients (39 of whom required emergent hemostatic procedures), Bruns and colleagues [ 10 ] found that a Hb level ≤ 10 g/dl, measured using the HemoCue ® POC device within 30 min of the patient’s arrival at hospital, was associated with a threefold increase in the need for an emergent hemostatic procedure. Other authors found that Hb measured upon admission was not accurate in identifying major injuries [ 11 , 12 ] or the need for an emergent hemostatic intervention [ 13 , 14 ]. In the present study, Hb-Lab hosp had a strong ability to predict SH (AUC of 0.92), but this measurement is taken in the laboratory and so results are subject to a delay.…”

Section: Discussionmentioning

confidence: 99%

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

Figueiredo

Taconet

Harrois

et al. 2018

Ann. Intensive Care

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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.

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Section: Discussionmentioning

confidence: 99%

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

Figueiredo

Taconet

Harrois

et al. 2018

Ann. Intensive Care

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“…8 Thorson and colleagues, in a study based on chart review, found that serial measurements were a good indicator of blood loss in trauma patients who had an initial assessment within the first 30 minutes of arrival and a second assessment within four hours, 1 but the study by Madsen suggests that serial measurements taken six hours apart rarely provide diagnostic information in trauma patients who are deemed stable for placement in observation units after the initial trauma screening. 5 Given that our assessment of the utility of serial hemoglobin primarily focused on the first five minutes of arrival to the resuscitation suite, our results cannot be generalized to different interval scales for serial hemoglobin measurements.…”

Section: Discussionmentioning

confidence: 94%

“…4 However, recent studies on the utility of serial measurements have produced inconclusive results. 1,4,5 These differing conclusions reflect differences in methodology, study populations, and the time frame of the serial evaluations.…”

Section: Introductionmentioning

confidence: 99%

Using Serial Hemoglobin Levels to Detect Occult Blood Loss in the Early Evaluation of Blunt Trauma Patients

Shahi

Mower

2018

The Journal of Emergency Medicine

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Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk

Kepros

Opreanu

Samaraweera

et al. 2012

Eur J Trauma Emerg Surg

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Ever since the introduction of radiographic imaging, its utility in identifying injuries has been well documented and was incorporated in the workup of injured patients during advanced trauma life support algorithms [American College of Surgeons, 8th ed. Chicago, 2008]. More recently, computerized tomography (CT) has been shown to be more sensitive than radiography in the diagnosis of injury. Due to the increased use of CT scanning, concerns were raised regarding the associated exposure to ionizing radiation [N Engl J Med 357:2277-2284, 2007]. During the last several years, a significant amount of research has been published on this topic, most of it being incorporated in the BEIR VII Phase 2 report, published by the National Research Council of the National Academies [National Academy of Sciences, Washington DC, 2006]. The current review will analyze the scientific basis for the concerns over the ionizing radiation associated with the use of CT scanning and will examine the accuracy of the typical advanced trauma life support work-up for diagnosis of injuries.

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Serial hematocrit testing does not identify major injuries in trauma patients in an observation unit

Cited by 3 publications

References 13 publications

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

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

Using Serial Hemoglobin Levels to Detect Occult Blood Loss in the Early Evaluation of Blunt Trauma Patients

Whole body imaging in the diagnosis of blunt trauma, ionizing radiation hazards and residual risk

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