Gabrielle E Hatton1, Michelle K McNutt2, Bryan A Cotton3, Jessica A Hudson4, Charles E Wade3, Lillian S Kao2. 1. Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX. Electronic address: gabrielle.e.hatton@uth.tmc.edu. 2. Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-Based Practice, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX. 3. Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX. 4. Division of Acute Care Surgery, Department of Surgery, University of Texas Health Science Center at Houston, Houston, TX; Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, TX; McGovern Medical School, and Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, TX.
Abstract
BACKGROUND: Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly trauma patients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly trauma patients. METHODS: We conducted a single-center cohort study of adult (16 years or older) trauma patients from 2016 to 2018 with base excess measured on arrival. Perfusion states were defined as shock if heart rate was >120 beats/min or systolic blood pressure was <90 mmHg; OH if base excess was < -2 mmol/L, heart rate was <120 beats/min, and systolic blood pressure was >90 mmHg; and normal for all others. Patients were stratified as young (younger than 55 years) or elderly (55 years or older). Bayesian regression was used to assess the relationship between arrival perfusion state and mortality or serious complication. RESULTS: Of 3,126 included patients, 808 were elderly. Rates of shock (33% and 31%) and OH (25% and 23%) were similar in young and elderly patients, respectively. OH on arrival was associated with higher odds of mortality or serious complication than normal perfusion, regardless of age group. Compared with shock, OH was associated with an odds ratio of 1.21 (95% CI, 0.97 to 1.52, posterior probability 96%) for poor outcomes in elderly patients and an odds ratio of 0.52 (95% CI, 0.42 to 0.65, posterior probability <1%) for poor outcomes in younger patients. Findings were similar on sensitivity analysis, excluding shock patients with base excess ≥ -2 mmol/L. CONCLUSIONS: In elderly but not younger patients, OH is associated with worse outcomes than shock. Although shock parameters might need to be redefined in elderly patients, more attention is necessary for the diagnosis and treatment of all hypoperfused states in this age group.
BACKGROUND:Occult hypoperfusion (OH), or global hypoperfusion with normal vital signs, is a risk factor for poor outcomes in elderly traumapatients. We hypothesized that OH is associated with worse outcomes than shock in both young and elderly traumapatients. METHODS: We conducted a single-center cohort study of adult (16 years or older) traumapatients from 2016 to 2018 with base excess measured on arrival. Perfusion states were defined as shock if heart rate was >120 beats/min or systolic blood pressure was <90 mmHg; OH if base excess was < -2 mmol/L, heart rate was <120 beats/min, and systolic blood pressure was >90 mmHg; and normal for all others. Patients were stratified as young (younger than 55 years) or elderly (55 years or older). Bayesian regression was used to assess the relationship between arrival perfusion state and mortality or serious complication. RESULTS: Of 3,126 included patients, 808 were elderly. Rates of shock (33% and 31%) and OH (25% and 23%) were similar in young and elderly patients, respectively. OH on arrival was associated with higher odds of mortality or serious complication than normal perfusion, regardless of age group. Compared with shock, OH was associated with an odds ratio of 1.21 (95% CI, 0.97 to 1.52, posterior probability 96%) for poor outcomes in elderly patients and an odds ratio of 0.52 (95% CI, 0.42 to 0.65, posterior probability <1%) for poor outcomes in younger patients. Findings were similar on sensitivity analysis, excluding shockpatients with base excess ≥ -2 mmol/L. CONCLUSIONS: In elderly but not younger patients, OH is associated with worse outcomes than shock. Although shock parameters might need to be redefined in elderly patients, more attention is necessary for the diagnosis and treatment of all hypoperfused states in this age group.
Authors: Jennifer C Richards; Anne R Crecelius; Dennis G Larson; Gary J Luckasen; Frank A Dinenno Journal: Am J Physiol Heart Circ Physiol Date: 2017-02-03 Impact factor: 4.733
Authors: Olubode A Olufajo; Samir Tulebaev; Houman Javedan; Jonathan Gates; Justin Wang; Maria Duarte; Edward Kelly; Elizabeth Lilley; Ali Salim; Zara Cooper Journal: J Am Coll Surg Date: 2016-03-03 Impact factor: 6.113
Authors: F Hildebrand; H-C Pape; K Horst; H Andruszkow; P Kobbe; T-P Simon; G Marx; T Schürholz Journal: Eur J Trauma Emerg Surg Date: 2015-08-08 Impact factor: 3.693
Authors: Andriy I Batchinsky; William H Cooke; Tom A Kuusela; Bryan S Jordan; Jing Jing Wang; Leopoldo C Cancio Journal: Auton Neurosci Date: 2007-05-04 Impact factor: 3.145
Authors: Brian J Eastridge; Jose Salinas; John G McManus; Lorne Blackburn; Eileen M Bugler; William H Cooke; Victor A Convertino; Victor A Concertino; Charles E Wade; John B Holcomb Journal: J Trauma Date: 2007-08
Authors: Heather R Kregel; Gabrielle E Hatton; Kayla D Isbell; Hanne H Henriksen; Jakob Stensballe; Per I Johansson; Lillian S Kao; Charles E Wade Journal: Shock Date: 2022-01-01 Impact factor: 3.533
Authors: Gabrielle E Hatton; Heather R Kregel; Claudia Pedroza; Thaddeus J Puzio; Sasha D Adams; Charles E Wade; Lillian S Kao; John A Harvin Journal: Ann Surg Date: 2021-10-01 Impact factor: 13.787
Authors: Tim Nutbeam; Anthony Kehoe; Rob Fenwick; Jason Smith; Omar Bouamra; Lee Wallis; Willem Stassen Journal: Scand J Trauma Resusc Emerg Med Date: 2022-03-05 Impact factor: 2.953