Characterization of acidosis in trauma patient
Background: Recent data suggest that acidosis alone is not a good predictor of mortality in trauma patients. Little data are currently available regarding factors associated with survival in trauma patients presenting with acidosis. Aims: The aims were to characterize the outcomes of trauma patients...
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Wolters Kluwer Medknow Publications
2020-01-01
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doaj-c9288dc77c7f45faaa5f340fe119aaad2020-11-25T03:55:56ZengWolters Kluwer Medknow PublicationsJournal of Emergencies, Trauma and Shock0974-27002020-01-0113321321810.4103/JETS.JETS_45_19Characterization of acidosis in trauma patientGregory S CorwinKevin W SextonWilliam C BeckJohn R TaylorAvi BhavarajuBenjamin DavisMary K KimbroughJoseph C JensenAnna PrivratskyRotnald D RobertsonBackground: Recent data suggest that acidosis alone is not a good predictor of mortality in trauma patients. Little data are currently available regarding factors associated with survival in trauma patients presenting with acidosis. Aims: The aims were to characterize the outcomes of trauma patients presenting with acidosis and to identify modifiable risk factors associated with mortality in these patients. Settings and Design: This is a retrospective observational study of University of Arkansas for Medical Sciences (UAMS) trauma patients between November 23, 2013, and May 21, 2017. Methods: Data were collected from the UAMS trauma registry. The primary outcome was hospital mortality. Analyses were performed using t-test and Pearson's Chi-squared test. Simple and multiple logistic regressions were performed to determine crude and adjusted odds ratios. Results: There were 532 patients identified and 64.7% were acidotic (pH < 7.35) on presentation: 75.9% pH 7.2–7.35; 18.5% pH 7.0–7.2; and 5.6% pH ≤ 7.0. The total hospital mortality was 23.7%. Nonsurvivors were older and more acidotic, with a base deficit >−8, Glasgow Coma Scale (GCS) ≤ 8, systolic blood pressure ≤ 90, International Normalized Ratio (INR) >1.6, and Injury Severity Score (ISS) >15. Mortality was significantly higher with a pH ≤ 7.2 but mortality with a pH 7.2–7.35 was comparable to pH > 7.35. In the adjusted model, pH ≤ 7.0, pH 7.0–7.2, INR > 1.6, GCS ≤ 8, and ISS > 15 were associated with increased mortality. For patients with a pH ≤ 7.2, only INR was associated with increase in mortality. Conclusions: A pH ≤ 7.2 is associated with increased mortality. For patients in this range, only the presence of coagulopathy is associated with increased mortality. A pH > 7.2 may be an appropriate treatment goal for acidosis. Further work is needed to identify and target potentially modifiable factors in patients with acidosis such as coagulopathy.http://www.onlinejets.org/article.asp?issn=0974-2700;year=2020;volume=13;issue=3;spage=213;epage=218;aulast=Corwinacidosisarterial blood gasbase deficitphtrauma |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Gregory S Corwin Kevin W Sexton William C Beck John R Taylor Avi Bhavaraju Benjamin Davis Mary K Kimbrough Joseph C Jensen Anna Privratsky Rotnald D Robertson |
spellingShingle |
Gregory S Corwin Kevin W Sexton William C Beck John R Taylor Avi Bhavaraju Benjamin Davis Mary K Kimbrough Joseph C Jensen Anna Privratsky Rotnald D Robertson Characterization of acidosis in trauma patient Journal of Emergencies, Trauma and Shock acidosis arterial blood gas base deficit ph trauma |
author_facet |
Gregory S Corwin Kevin W Sexton William C Beck John R Taylor Avi Bhavaraju Benjamin Davis Mary K Kimbrough Joseph C Jensen Anna Privratsky Rotnald D Robertson |
author_sort |
Gregory S Corwin |
title |
Characterization of acidosis in trauma patient |
title_short |
Characterization of acidosis in trauma patient |
title_full |
Characterization of acidosis in trauma patient |
title_fullStr |
Characterization of acidosis in trauma patient |
title_full_unstemmed |
Characterization of acidosis in trauma patient |
title_sort |
characterization of acidosis in trauma patient |
publisher |
Wolters Kluwer Medknow Publications |
series |
Journal of Emergencies, Trauma and Shock |
issn |
0974-2700 |
publishDate |
2020-01-01 |
description |
Background: Recent data suggest that acidosis alone is not a good predictor of mortality in trauma patients. Little data are currently available regarding factors associated with survival in trauma patients presenting with acidosis. Aims: The aims were to characterize the outcomes of trauma patients presenting with acidosis and to identify modifiable risk factors associated with mortality in these patients. Settings and Design: This is a retrospective observational study of University of Arkansas for Medical Sciences (UAMS) trauma patients between November 23, 2013, and May 21, 2017. Methods: Data were collected from the UAMS trauma registry. The primary outcome was hospital mortality. Analyses were performed using t-test and Pearson's Chi-squared test. Simple and multiple logistic regressions were performed to determine crude and adjusted odds ratios. Results: There were 532 patients identified and 64.7% were acidotic (pH < 7.35) on presentation: 75.9% pH 7.2–7.35; 18.5% pH 7.0–7.2; and 5.6% pH ≤ 7.0. The total hospital mortality was 23.7%. Nonsurvivors were older and more acidotic, with a base deficit >−8, Glasgow Coma Scale (GCS) ≤ 8, systolic blood pressure ≤ 90, International Normalized Ratio (INR) >1.6, and Injury Severity Score (ISS) >15. Mortality was significantly higher with a pH ≤ 7.2 but mortality with a pH 7.2–7.35 was comparable to pH > 7.35. In the adjusted model, pH ≤ 7.0, pH 7.0–7.2, INR > 1.6, GCS ≤ 8, and ISS > 15 were associated with increased mortality. For patients with a pH ≤ 7.2, only INR was associated with increase in mortality. Conclusions: A pH ≤ 7.2 is associated with increased mortality. For patients in this range, only the presence of coagulopathy is associated with increased mortality. A pH > 7.2 may be an appropriate treatment goal for acidosis. Further work is needed to identify and target potentially modifiable factors in patients with acidosis such as coagulopathy. |
topic |
acidosis arterial blood gas base deficit ph trauma |
url |
http://www.onlinejets.org/article.asp?issn=0974-2700;year=2020;volume=13;issue=3;spage=213;epage=218;aulast=Corwin |
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