Ph, base deficit, lactate, and strong ion difference and gap, but not anion gap, predict outcome from vascular injury

Lewis Kaplan, Heathertee Bailey, Rosemary Kozar, Thomas Santora, Stanley Trooskin

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Introduction: This study determines whether acid-base data obtained in the Emergency Department predict outcome from major vascular injury. Methods: A Level 1 Trauma facility's data (1/88-12/97) of trauma patients with SBP< 90mm Hg requiring vascular repair were reviewed. IRB approved data for abstraction included: age, Injury Severity Score (ISS), injury mechanism, survival, ABG, albumin, electrolytes, lactate, base deficit (BD), anion gap (AG), strong ion difference and gap (SID, SIG). Comparisons between survivors (SUR) and non-survivors (NON) were by two tailed unpaired t-test; significance was assumed for p ≤ 0.05. Results: Both NON (n=64) and SUR (n=219) were similar with respect to age (31± 9 v 31.5 ± 10.5, p>.05), and injury mechanics (blunt 17%, penetrating 83% in SUR v blunt 18%, penetrating 82% in NON, p> .05). NON had more multi-cavitary injury (46% v 17%, p<.05) than SUR. NON ISS exceeded that of SUR (27.9 ± 12.4 v 13.2 ± 12.5, p<.05). NON pH (7.06 ± 0.19 v 7.29 ± 0.09, p<.05) and SID (30.3 ± 2.1 v 39 ± 1.6, p<.05) was lower while NON BD (14.9 ± 7.2 v 4.2 ± 1.9, p<.05). lactate (11.6 ± 2.9 v 3.6 ± 1.4, p<.05), AG (15.6 ± 7.3 v 8.4 ± 3.1, p<.05) and SIG (10.8 ± 7.1 v 2.1 ± 0.9, p<.05) were higher. However, the AG was normal in 42% of NON. All but one nonsurvivor had a pH≤7.26, BD≥4, lactate≥5, SID≤32 and SIG≥4. Conclusions: The initial Emergency Department acid-base parameters of pH, BD, lactate, SID and SIG, but not AG presage poor outcome from major vascular injury and should be assayed on presentation. The anion gap underestimates the severity of acid-base derangements in patients with major vascular injury.

Original languageEnglish (US)
JournalCritical care medicine
Volume27
Issue number1 SUPPL.
StatePublished - Dec 1 1999
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

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