BACKGROUND: Occult hypoperfusion (OH) is defined as hypoperfusion in the presence of normal vital signs. It is associated with increased length of stay (LOS) and increased mortality. OBJECTIVES: To compare four methods of detecting OH in adult major trauma patients at a level 1 trauma centre-base excess (BE), non-invasive cardiac index (CI), shock index (SI) and rate over pressure evaluation (ROPE). METHOD: Patients meeting the Victorian Trauma Registry entrance criteria who presented with normal vital signs were enrolled. CI was obtained half hourly using an USCOM monitor. BE, SI and ROPE were obtained clinically. RESULTS: Sixty-four patients were enrolled. Mean injury severity score (ISS) was 19 (SD 11) and mean hospital LOS was 10 days (SD 8). Two patients (3%) died in hospital. Ten patients (16%) had OH detected by CI, seven (11%) by BE, four (6%) by SI and two (3%) by ROPE. There was a significant association between hospital LOS and BE (p<0.005). Agreement between BE and CI in detecting OH was poor to fair, kappa=0.25. CONCLUSION: OH is associated with increased hospital LOS and occurs in up to 16% of patients. BE performed best as a detection method.
BACKGROUND:Occult hypoperfusion (OH) is defined as hypoperfusion in the presence of normal vital signs. It is associated with increased length of stay (LOS) and increased mortality. OBJECTIVES: To compare four methods of detecting OH in adult major traumapatients at a level 1 trauma centre-base excess (BE), non-invasive cardiac index (CI), shock index (SI) and rate over pressure evaluation (ROPE). METHOD:Patients meeting the Victorian Trauma Registry entrance criteria who presented with normal vital signs were enrolled. CI was obtained half hourly using an USCOM monitor. BE, SI and ROPE were obtained clinically. RESULTS: Sixty-four patients were enrolled. Mean injury severity score (ISS) was 19 (SD 11) and mean hospital LOS was 10 days (SD 8). Two patients (3%) died in hospital. Ten patients (16%) had OH detected by CI, seven (11%) by BE, four (6%) by SI and two (3%) by ROPE. There was a significant association between hospital LOS and BE (p<0.005). Agreement between BE and CI in detecting OH was poor to fair, kappa=0.25. CONCLUSION: OH is associated with increased hospital LOS and occurs in up to 16% of patients. BE performed best as a detection method.
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