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Physiological predictors of death in exsanguinating trauma patients undergoing conventional trauma surgery.

BACKGROUND
Severe truncal multi trauma patients often develop coagulopathy, acidosis and hypothermia that makes major reparative trauma surgery dangerous. It was aimed to try to develop physiological indicators that would predict a poor outcome when conventional reparative surgery was applied. These indicators may help in the decision to switch from conventional reparative surgery to surgery limited to the control of major haemorrhage or organ disruption: so-called 'damage-control' surgery.


METHOD
A retrospective review was conducted of 40 patients with severe multivisceral trauma (Injury Severity Score (ISS) > 35) who were admitted to the intensive care unit at Waikato Hospital and who underwent conventional reparative surgery.


RESULTS
Survival was strongly associated with base deficit (BD), core temperature and ISS. Using multiple logistic regression on these indices, outcome could be predicted with 92.5% accuracy (sensitivity = 93%, specificity = 92%, positive predictive value for death = 96%). Either severe hypothermia (< 33 degrees C) or severe acidosis (BD > 12 mEq/L), or a combination of moderate core temperature < 35.5 degrees C, and a BD of > 5 mEq/L were strong predictors of death if conventional reparative surgery was practised.


CONCLUSIONS
At the above mentioned levels of physiological compromise, patient survival after conventional trauma surgery can be predicted to be very unlikely. Damage-control measures would be worth attempting.