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Observational Study
. 2016 Mar;23(3):353-7.
doi: 10.1111/acem.12899. Epub 2016 Feb 29.

Muscle Oxygen Saturation Improves Diagnostic Association Between Initial Vital Signs and Major Hemorrhage: A Prospective Observational Study

Free PMC article
Observational Study

Muscle Oxygen Saturation Improves Diagnostic Association Between Initial Vital Signs and Major Hemorrhage: A Prospective Observational Study

Andrew T Reisner et al. Acad Emerg Med. .
Free PMC article


Objectives: During initial assessment of trauma patients, vital signs do not identify all patients with life-threatening hemorrhage. We hypothesized that a novel vital sign, muscle oxygen saturation (SmO2 ), could provide independent diagnostic information beyond routine vital signs for identification of hemorrhaging patients who require packed red blood cell (RBC) transfusion.

Methods: This was an observational study of adult trauma patients treated at a Level I trauma center. Study staff placed the CareGuide 1100 tissue oximeter (Reflectance Medical Inc., Westborough, MA), and we analyzed average values of SmO2 , systolic blood pressure (sBP), pulse pressure (PP), and heart rate (HR) during 10 minutes of early emergency department evaluation. We excluded subjects without a full set of vital signs during the observation interval. The study outcome was hemorrhagic injury and RBC transfusion ≥ 3 units in 24 hours (24-hr RBC ≥ 3). To test the hypothesis that SmO2 added independent information beyond routine vital signs, we developed one logistic regression model with HR, sBP, and PP and one with SmO2 in addition to HR, sBP, and PP and compared their areas under receiver operating characteristic curves (ROC AUCs) using DeLong's test.

Results: We enrolled 487 subjects; 23 received 24-hr RBC ≥ 3. Compared to the model without SmO2 , the regression model with SmO2 had a significantly increased ROC AUC for the prediction of ≥ 3 units of 24-hr RBC volume, 0.85 (95% confidence interval [CI], 0.75-0.91) versus 0.77 (95% CI, 0.66-0.86; p < 0.05 per DeLong's test). Results were similar for ROC AUCs predicting patients (n = 11) receiving 24-hr RBC ≥ 9.

Conclusions: SmO2 significantly improved the diagnostic association between initial vital signs and hemorrhagic injury with blood transfusion. This parameter may enhance the early identification of patients who require blood products for life-threatening hemorrhage.


Figure 1
Figure 1
Flowchart of subject enrollment. *Data archiving failures involved the archiving system (ruggedized GoBook personal computer connected to the CareGuide SmO2 sensor) that we assembled for this investigation. For the final 16 months of the investigation, we reinforced the electronic and mechanical connectivity, and had only one additional subject with data archiving failure in that time interval. BMI = body mass index; BP = blood pressure; HR = heart rate; IRB = institutional review board; NIRS = near‐infrared spectrometry.

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    1. Brockamp T, Nienaber U, Mutschler M, et al. Predicting on‐going hemorrhage and transfusion requirement after severe trauma: a validation of six scoring systems and algorithms on the TraumaRegister DGU. Crit Care 2012;16:R129. - PMC - PubMed
    1. Cohn SM, Nathens AB, Moore FA, et al. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 2007;62:44–54. - PubMed
    1. Moore FA, Nelson T, McKinley BA, et al. Massive transfusion in trauma patients: tissue hemoglobin oxygen saturation predicts poor outcome. J Trauma 2008;64:1010–23. - PubMed
    1. Sagraves SG, Newell MA, Bard MR, et al. Tissue oxygenation monitoring in the field: a new EMS vital sign. J Trauma 2009;67:441–3. - PubMed
    1. Beekley AC, Martin MJ, Nelson T, et al. Continuous noninvasive tissue oximetry in the early evaluation of the combat casualty: a prospective study. J Trauma 2010;69(Suppl 1):S14–25. - PubMed

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