PMID- 22988401
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20120919
LR  - 20211021
IS  - 0974-519X (Electronic)
IS  - 0974-2700 (Print)
IS  - 0974-2700 (Linking)
VI  - 5
IP  - 3
DP  - 2012 Jul
TI  - Utility of admission physiology in the surgical triage of isolated ballistic 
      battlefield torso trauma.
PG  - 233-7
LID - 10.4103/0974-2700.99690 [doi]
AB  - 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.
FAU - Morrison, Jonathan J
AU  - Morrison JJ
AD  - Academic Department of Military Surgery and Trauma, Royal Centre for Defence 
      Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham B15 2SQ, 
      UK.
FAU - Dickson, Euan J
AU  - Dickson EJ
FAU - Jansen, Jan O
AU  - Jansen JO
FAU - Midwinter, Mark J
AU  - Midwinter MJ
LA  - eng
PT  - Journal Article
PL  - India
TA  - J Emerg Trauma Shock
JT  - Journal of emergencies, trauma, and shock
JID - 101493921
PMC - PMC3440889
OTO - NOTNLM
OT  - Battlefield torso trauma
OT  - shock index
OT  - trauma surgery
OT  - triage
COIS- Conflict of Interest: None declared.
EDAT- 2012/09/19 06:00
MHDA- 2012/09/19 06:01
PMCR- 2012/07/01
CRDT- 2012/09/19 06:00
PHST- 2011/06/22 00:00 [received]
PHST- 2011/09/07 00:00 [accepted]
PHST- 2012/09/19 06:00 [entrez]
PHST- 2012/09/19 06:00 [pubmed]
PHST- 2012/09/19 06:01 [medline]
PHST- 2012/07/01 00:00 [pmc-release]
AID - JETS-5-233 [pii]
AID - 10.4103/0974-2700.99690 [doi]
PST - ppublish
SO  - J Emerg Trauma Shock. 2012 Jul;5(3):233-7. doi: 10.4103/0974-2700.99690.