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Prognostic value of metabolic parameters measured by first responders attending patients with severe trauma: associations with the New Injury Severity Score and mortality

Corral Torres E , Hern√°ndez-Tejedor A, Mill√°n Esta√Ī P, Valiente Fern√°ndez M, Bringas Bollada M, P√©rez D√≠az D, Monforte-Escobar F, Vejo Guti√©rrez J, Orej√≥n Garc√≠a L, Delgado Pascual A, Rey Valc√°rcel C, Camacho Leis C

SAMUR-Protecci√≥n Civil, Madrid, Spain. Service of Intensive Care Medicine, Hospital Universitario La Paz, Madrid, Spain. Intensive Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain. Service of Intensive Care Medicine, Hospital Universitario Cl√≠nico San Carlos, Madrid, Spain. General Surgery Department, Hospital Universitario Gregorio Mara√Ī√≥n, Madrid, Spain.

Background and objective. Patients with severe or potentially severe trauma must be identified early, a challenge in prehospital settings. This study aimed to analyze the possible diagnostic and prognostic usefulness of analytical markers recorded in the early moments of care.
Methods. Observational study of information extracted from the prospective multicenter Code Trauma database for 2016-2019, excluding data for isolated head injuries. Using the New Injury Severity Score (NISS), we classified cases into 4 levels of severity. NISS and mortality were considered the dependent variables in inferential analyses. We calculated the areas under receiver operating characteristic curves, identified optimal cutoff points (Youden index), and calculated positive (PPV) and negative predictive values.
Results. Of the 1039 trauma patients in the registry, 709 were included in the study. Their mean (SD) age was 40.4 (17.3) years, and 77.3% were men. Motorcycle accidents were the most common causes of trauma (in 21%), and mortality was 12.1%. Lactate concentration, pH, PCO2, hemoglobin concentration, hematocrit, and blood sugar were
significantly associated with severity and mortality. The PPVs corresponding to pH for the 4 NISS score groups (34-41, 42-49, 50-59, and $ 60) and mortality, respectively, were 61.2, 64.1, 70.7, 62.2, and 66.6. The PPVs of traditionally used clinical variables were lower.
Conclusions. Patients with more severe trauma had lower pH values and higher PCO2, lactate, and base excess values. PCO2, pH, and blood sugar findings were the best predictors of severity. Metabolic variables are better predictors than traditionally recorded hemodynamic variables.

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