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

Shahi, Vikas; Shahi, Varun; Mower, William R.

doi:10.1016/j.jemermed.2018.06.017

Cited by 3 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Then, prehospital fluid resuscitation induces further hemodilution and fall in Hct and Hb. Therefore, serial measurements are recommended for the evaluation of trauma-related hemorrhage [18,19], but the results are still controversial [17,20].…”

Section: Introductionmentioning

confidence: 99%

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

Jávor

Donka

Horváth

et al. 2023

JCM

View full text Add to dashboard Cite

The majority of potentially preventable mortality in trauma patients is related to bleeding; therefore, early recognition and effective treatment of hemorrhagic shock impose a cardinal challenge for trauma teams worldwide. The reduction in mesenteric perfusion (MP) is among the first compensatory responses to blood loss; however, there is no adequate tool for splanchnic hemodynamic monitoring in emergency patient care. In this narrative review, (i) methods based on flowmetry, CT imaging, video microscopy (VM), measurement of laboratory markers, spectroscopy, and tissue capnometry were critically analyzed with respect to their accessibility, and applicability, sensitivity, and specificity. (ii) Then, we demonstrated that derangement of MP is a promising diagnostic indicator of blood loss. (iii) Finally, we discussed a new diagnostic method for the evaluation of hemorrhage based on exhaled methane (CH4) measurement. Conclusions: Monitoring the MP is a feasible option for the evaluation of blood loss. There are a wide range of experimentally used methodologies; however, due to their practical limitations, only a fraction of them could be integrated into routine emergency trauma care. According to our comprehensive review, breath analysis, including exhaled CH4 measurement, would provide the possibility for continuous, non-invasive monitoring of blood loss.

show abstract

Section: Introductionmentioning

confidence: 99%

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

Jávor

Donka

Horváth

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…While there is evidence that a low Hgb level soon after injury can be an indicator of serious ongoing hemorrhage, 4,5 more data have shown that isolated and serial Hgb levels in the initial evaluation of patients confuse the clinical picture and lead to inconsistencies when determining if a patient needs surgical management. [6][7][8][9][10][11][12] In a systematic review looking at prognostic factors for the failure of NOM, Hgb levels did not adequately predict the failure of NOM. 13 According to the Eastern Association for the Surgery of Trauma (EAST), there is not substantial evidence to recommend duration or frequency of hemoglobin measurements for splenic injuries undergoing NOM.…”

Section: Introductionmentioning

confidence: 99%

The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury

Poupore

Boswell

Baginski

et al. 2021

The American Surgeon

View full text Add to dashboard Cite

Background The Eastern Association for the Surgery of Trauma (EAST) states there is not enough evidence to recommend a particular frequency of measuring Hgb values for non-operative management (NOM) of blunt splenic injury (BSI). This study was performed to compare the utility of serial Hgb (SHgb) to daily Hgb (DHgb) in this population. Methods We conducted a retrospective chart review of patients with BSI between 2013 and 2019. Demographics, comorbidities, lab values, clinical decisions, and outcomes were gathered through a trauma database. Results A total of 562 patients arrive in the trauma bay with BSI. In the NOM group, 297 were successful and 37 failed NOM. Of those that failed NOM, 8 (21.6%) changed to OM due to a drop in Hgb. 5 (62.5%) were hypotensive first, 2 (25%) were no longer receiving SHgb, and 1 (12.5%) had a repeat CT scan and was embolized. DHgb patients were not significantly different from SHgb patients in injury severity, length of stay, the largest drop in Hgb, and incidence of failing NOM. Patients taking aspirin were more likely to fall below 7 g/dl at 48 and 72 hours into admission. Conclusions These results suggest that that trending SHgb may not influence clinical decision-making in NOM of BSI. Besides taking aspirin, risk factors for who would benefit from SHgb were not identified. Patients who received DHgb had similar injuries and outcomes than patients who received SHgb. Prospective studies are needed to evaluate the clinical utility of SHgb compared to DHgb.

show abstract

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran

Paydar

Akerdi

Nikseresht

et al. 2021

Chinese Journal of Traumatology

View full text Add to dashboard Cite

Purpose Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients. Methods In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t -test and ANOVA with repeated data and paired samples t -test. Results A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy ( p < 0.003), and the coagulation profile worsened although the change was not statistically significant. Conclusion The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.

show abstract

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

Abstract: Our results indicated that ΔHgb does not reliably distinguish between blunt trauma patients who require intervention and those who do not.

Cited by 3 publications

References 7 publications

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

Impairment of Mesenteric Perfusion as a Marker of Major Bleeding in Trauma Patients

The Utility of Serial Hemoglobin Monitoring in Non-Operative Management of Blunt Splenic Injury

Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran

Contact Info

Product

Resources

About