The impact of severe traumatic brain injury on a novel base deficit- based classification of
hypovolemic shock
Sammanfattning
Recently, our group has proposed a new classification of hypovolemic shock based on the
physiological shock marker base deficit (BD). The classification consists of four groups of worsening
BD and correlates with the extent of hypovolemic shock in severely injured patients. The aim of this
study was to test the applicability of our recently proposed classification of hypovolemic shock in the
context of severe traumatic brain injury (TBI).
METHODS:
Between 2002 and 2011, patients ?16 years in age with an AIShead ? 3 have been retrieved from the
German TraumaRegister DGU(®) database. Patients were classified into four strata of worsening BD
[(class I (BD ? 2 mmol/l), class II (BD > 2.0 to 6.0 mmol/l), class III (BD > 6.0 to 10 mmol/l) and class
IV (BD > 10 mmol/l)] and assessed for demographic and injury characteristics as well as blood
product transfusions and outcomes. The cohort of severely injured patients with TBI was compared to
a population of all trauma patients to assess possible differences in the applicability of the BD based
classification of hypovolemic shock.
RESULTS:
From a total of 23,496 patients, 10,201 multiply injured patients with TBI (AIShead ? 3) could be
identified. With worsening of BD, a consecutive increase of mortality rate from 15.9% in class I to
61.4% in class IV patients was observed. Simultaneously, injury severity scores increased from 20.8
(±11.9) to 41.6 (±17). Increments in BD paralleled decreasing hemoglobin, platelet counts and Quick's
values. The number of blood units transfused correlated with worsening of BD. Massive transfusion
rates increased from 5% in class I to 47% in class IV. Between multiply injured patients with TBI and
all trauma patients, no clinically relevant differences in transfusion requirement or massive
transfusion rates were observed.
CONCLUSION:
The presence of TBI has no relevant impact on the applicability of the recently proposed BD-based
classification of hypovolemic shock. This study underlines the role of BD as a relevant clinical
indicator of hypovolaemic shock during the initial assessment in respect to haemostatic resuscitation
and transfusion requirements.