Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

BMC Surg. 2004 Jan 19;4:3. doi: 10.1186/1471-2482-4-3.

Abstract

Background: We sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate), and impaired pulmonary physiology (decreased spirometric volume and PaO2/FiO2).

Methods: Level I trauma center prospective pilot and post-pilot study (2000-2001) of stable patients. Increased base deficit was < 0.0 in ethanol-negative and < or = -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol/L in ethanol-negative and > or = 3.0 mmol/L in ethanol-positive patients. Decreased PaO2/FiO2 was < 350 and decreased spirometric volume was < 1.8 L.

Results: Of 215 patients, 66 (30.7%) had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43). Glasgow Coma Scale score was 14.8 +/- 0.5 (13-15). Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO2/FiO2, and spirometric volume--0.0% & 0.0%; normal base deficit and normal spirometric volume--4.2% & 4.5%; chest/abdominal soft tissue injury--37.8% & 47.0%; increased lactate--39.7% & 47.0%; increased base deficit--41.3% & 75.8%; increased base deficit and/or decreased spirometric volume--43.8% & 95.5%; decreased PaO2/FiO2--48.9% & 33.3%; positive abdominal ultrasound--62.5% & 7.6%; decreased spirometric volume--73.4% & 71.2%; increased base deficit and decreased spirometric volume--82.9% & 51.5%.

Conclusions: Trauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2/FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.

MeSH terms

  • Abdominal Injuries / diagnosis
  • Abdominal Injuries / epidemiology
  • Abdominal Injuries / physiopathology*
  • Acidosis / epidemiology
  • Acidosis / physiopathology*
  • Adult
  • Ambulatory Care / statistics & numerical data*
  • Comorbidity
  • Fractures, Bone / diagnosis
  • Fractures, Bone / epidemiology
  • Fractures, Bone / physiopathology
  • Glasgow Coma Scale
  • Humans
  • Incidence
  • Lactates / metabolism
  • Middle Aged
  • Pelvis / diagnostic imaging
  • Pelvis / injuries*
  • Prospective Studies
  • Radiography
  • Risk Assessment
  • Spirometry*
  • Thoracic Injuries / diagnosis
  • Thoracic Injuries / epidemiology
  • Thoracic Injuries / physiopathology*
  • Ultrasonography
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / epidemiology
  • Wounds, Nonpenetrating / physiopathology
  • Wounds, Penetrating / diagnosis
  • Wounds, Penetrating / epidemiology
  • Wounds, Penetrating / physiopathology

Substances

  • Lactates