Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma
Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT). Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective a...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2012-01-01
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| Series: | Journal of Emergencies, Trauma and Shock |
| Subjects: | |
| Online Access: | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2012;volume=5;issue=3;spage=233;epage=237;aulast=Morrison |
| _version_ | 1818011029602304000 |
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| author | Jonathan J Morrison Euan J Dickson Jan O Jansen Mark J Midwinter |
| author_facet | Jonathan J Morrison Euan J Dickson Jan O Jansen Mark J Midwinter |
| author_sort | Jonathan J Morrison |
| collection | DOAJ |
| description | Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT). Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts′ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH) and those not requiring immediate surgery (non-LTTH). Statistical Analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher′s exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD) was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP), pulse pressure, shock index (SI=heart rate/SBP) and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI) is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context. |
| first_indexed | 2024-04-14T06:02:08Z |
| format | Article |
| id | doaj.art-e70edfb79fe6482a94bd9acdd8af660b |
| institution | Directory Open Access Journal |
| issn | 0974-2700 |
| language | English |
| last_indexed | 2024-04-14T06:02:08Z |
| publishDate | 2012-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Emergencies, Trauma and Shock |
| spelling | doaj.art-e70edfb79fe6482a94bd9acdd8af660b2022-12-22T02:08:42ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002012-01-015323323710.4103/0974-2700.99690Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso traumaJonathan J MorrisonEuan J DicksonJan O JansenMark J MidwinterBackground: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT). Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability. Settings and Design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan. Materials and Methods: The cohorts′ admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH) and those not requiring immediate surgery (non-LTTH). Statistical Analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher′s exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values. Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD) was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP), pulse pressure, shock index (SI=heart rate/SBP) and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively. Conclusions: Shock index (SI) is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2012;volume=5;issue=3;spage=233;epage=237;aulast=MorrisonBattlefield torso traumashock indextrauma surgerytriage |
| spellingShingle | Jonathan J Morrison Euan J Dickson Jan O Jansen Mark J Midwinter Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma Journal of Emergencies, Trauma and Shock Battlefield torso trauma shock index trauma surgery triage |
| title | Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| title_full | Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| title_fullStr | Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| title_full_unstemmed | Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| title_short | Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| title_sort | utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma |
| topic | Battlefield torso trauma shock index trauma surgery triage |
| url | http://www.onlinejets.org/article.asp?issn=0974-2700;year=2012;volume=5;issue=3;spage=233;epage=237;aulast=Morrison |
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