Indication (variable included in statistical analyses) | % DC pts in the study | Confounding factors adjusted for | Outcome | Predictive validity |
---|---|---|---|---|
Preoperative indications | ||||
Overall injury burden | ||||
High ISS | 0 | BD, temperature | Survival | BD, temperature OR per ISS ↑, 1.12 (95% CI, 1.03 to 1.23) [57] |
100 | None | Survival | ↑ mean ISS in non-survivors vs. survivors (38 vs. 29, p < 0.05) [61] | |
Volume and/or type of resuscitation provided | ||||
Transfusion of a large volume of PRBCs | 100 | None | Survival | ↑ mean U PRBCs transfused in non-survivors vs. survivors (20 vs. 14, p < 0.01) [61] |
Degree of physiologic insult | ||||
Prolonged duration of hypotension | 100 | None | Survival | ↑ mean duration of preoperative hypotension in non-survivors vs. survivors (90 vs. 50 min., p < 0.05) [61] |
Hypothermia (min temperature) | 0 | BD, ISS | Survival | OR per min temperature ↓ in °C, 0.32 (95% CI, 0.15 to 0.64) [57] |
Temperature < 35 °C | 100 | Age, BD, pH | Survival | ↓ temperature not independently associated with survival [47] |
Elevated BD (max BD) | 0 | ISS, temperature | Survival | OR per max BD ↑, 0.66 (95% CI, 0.56 to 0.78) [57] |
BD > 10.5 mEq/L | 100 | Age, pH, temperature | Survival | ↑ BD not independently associated with survival [47] |
Decreased pH | 100 | None | Survival | ↓ mean pH in non-survivors vs. survivors (7.1 vs. 7.3, p < 0.05) [61] |
pH < 7.20 | 100 | Age, BD, temperature | Survival | ↑ pH independently associated with ↓ survival (p = 0.001) [47] |
Decreased platelet count | 100 | None | Survival | ↓ mean platelet count in non-survivors vs. survivors (179,000 vs. 229,000 mm3) [61] |
Laboratory-confirmed coagulopathy | 100 | None | Survival | ↑ mean PT (22 vs. 14 s) and PTT (69 vs. 42 s) in non-survivors vs. survivors (p < 0.05 for both) [61] |
PT ≥ 16 s | 100 | None | Survival | OR, 0.11 (p < 0.05) [63] |
PTT ≥ 50 s | 100 | None | Survival | OR, 0 (survival, 0% vs. 71% with PTT <50 sec; p < 0.05) [63] |
A model included highest ED BD, lowest ED temperature, and ISS | 0 | BD, lowest ED temperature, ISS | Survival | Model Se, 83%; model Sp, 93% [57] |
A model predicting that survival was possible only when the equation 0.012(age) - 0.707(lowest preoperative pH) - 0.032(lowest preoperative temperature in °C) + 6.002 = < 0.5 | 100 | None | Survival | Model Se, 25%; model PPV, 100% [49] |
Intraoperative indications | ||||
Injury pattern identified during operation | ||||
Combined abdominal vascular and pancreas gunshot injuries | 20 | 12 variablesa | Survival | OR, 0.12 (95% CI, 0.041–0.36) [44] |
20 | 11 variablesa | Complications | OR, 3.59 (95% CI, 1.10–11.68) [44] | |
Iliac vessel injury and prolonged duration of hypotension | 22 | None | Survival | ↑ mean duration of hypotension in non-survivors vs. survivors who underwent definitive (95 vs. 65 min, p value NR) and DC (40 vs. 85 min, p < 0.05) laparotomy [58] |
Iliac vessel injury and initial temperature < 34 °C | 17 | None | Survival | OR, 0.27 (95% CI, 0.072-1.0) [59] |
Iliac vessel injury and final temperature < 35 °C | 17 | None | Survival | OR, 0.025 (95% CI, 0.0028-0.23) [59] |
Iliac vessel injury and initial BD > 15 mEq/L | 17 | None | Survival | OR, 0.037 (95% CI, 0.0072-0.19) [59] |
Iliac vessel injury and final BD > 6 mEq/L | 17 | None | Survival | OR, 0.091 (95% CI, 0.019–0.45) [59] |
Iliac vessel injury and initial pH < 7.1 | 17 | None | Survival | OR, 0.032 (95% CI, 0.0055–0.19) [59] |
Iliac vessel injury and final pH < 7.3 | 17 | None | Survival | OR, 0.069 (95% CI, 0.014–0.36) [59] |
Penetrating iliac vessel injury and final pH < 7.2 | 22 | None | Survival | ↓ mean final pH in non-survivors vs. survivors who underwent definitive (7.11 vs. 7.29, p value NR) and DC (7.20 vs. 7.32, p value < 0.05) [58] |
Penetrating iliac vessel injury and final PT > 20 s | 22 | None | Survival | ↑ final PT in non-survivors vs. survivors who underwent definitive (25.2 vs. 17.8 sec, p value NR) and DC (20.2 vs. 15.9 s, p < 0.05) laparotomy [58] |
Penetrating iliac vessel injury and final PTT >70 s | 22 | None | Survival | ↑ final PTT in non-survivors vs. survivors who underwent definitive (86.1 vs. 59.2 s, p value NR) and DC (66.2 vs. 47.8 s, p < 0.05) laparotomy [58] |
Iliac vessel injury and shock, hypothermia, acidosis, or coagulopathy (timing of measurement not specified) | 18 | ≤ 14 variablesb | Survival | Shock, hypothermia, acidosis, and coagulopathy not independently associated with survival [54] |
Volume and/or type of resuscitation provided | ||||
Transfusion > 4 L PRBCs | 100 | 23 variablesb | Survival | Independently associated with ↓ survival [56] |
Transfusion > 5 L PRBCs and whole blood | 100 | None | Survival | ↑ mean volume of PRBCs and whole blood in non-survivors vs. survivors (8.2 vs. 5.6 L, p < 0.001) [56] |
Administration > 12 L PRBCs and/or whole blood, other blood products, and crystalloids | 100 | None | Survival | ↑ mean volume of these fluids in non-survivors vs. survivors (15.0 vs. 12.4 L, p < 0.001) [56] |
Degree of physiologic insult | ||||
Temperature ≤ 34 °C | 100 | None | Survival | ↓ mean min temperature in non-survivors vs. survivors (33.9 vs. 35.0, p < 0.001) [56] |
Serum [HCO3-] ≤ 15 mEq/L | 100 | None | Survival | Serum [HCO3-] ≤ 15 mEq/L associated with ↓ survival [56] |
pH < 7.2 | 100 | None | Survival | ↓ mean initial (7.1 vs. 7.4), max (7.2 vs. 7.4), and min (7.0 vs. 7.2) pH in non-survivors vs. survivors (p < 0.001 for all) [56] |
Elevated ACT | 23 | Unclear for logistic regression | Clinical coagulo-pathyc | The mean of 2 ACT measurements (taken within the first 10 min of beginning surgery and repeated ~ 15 min later) was 180 s in patients with coagulopathy versus 118 s in those without (p < 0.001) [53] The 1st, 2nd, and mean ACT values were independently associated with coagulopathy using logistic regression (p value NR) [53] |
Systolic BP < 90 mmHg, BD > 7.5 mEq/L, and/or temperature < 35.5 °C at the start of surgery | 100 | None | Survival | OR for survival was 0.13 (95% CI, 0.021-0.77) among patients who presented with all 3 vs. < 3 variables. There was also a stepwise ↓ in survival as the no. of variables present ↑ [48] |
A model predicted that survival was only possible when patients lie below and to the right of a diagonal discriminant line given by the equation PRBC transfusion rate (U/h) = 35.7(arterial pH) - 242 (for an arterial pH = 7.2, transfusion rate = 15 U/h) | 100 | PRBC transfusion rate, pH | 48 h survival | Model Se, 77% [65] |
Pre- or intraoperative indications (or indications for which the setting was unclear or not specified) | ||||
Volume and/or type of resuscitation provided | ||||
Transfusion > 15 U PRBCs | 100 | None | Coagulopathyd | OR, 6.0 (95% CI, 0.67–75.61) [66] |
Transfusion > 10 U PRBCs in the first 24 h and an ISS > 25 | 31 | PRBCs transfused in 24 h, lowest systolic BP < 70 mmHg, pH < 7.1, and temperature < 34 °C | PT & PTT > 2acontrol | OR, 7.7 (95% CI, 1.5–38.8) [60]e |
Transfusion > 10 U PRBCs in the first 6 h and an ISS >25 | NR | 9 variablesf | INR > 1.5 at 6 h | OR, 4.14 (95% CI, 0.57–3.18) [50] |
Transfusion > 10 U PRBCs in the first 24 h and the lowest systolic BP < 70 mmHg | 31 | ISS > 25, PRBCs transfused in 24 h, pH < 7.1, and temperature < 34 °C | PT & PTT > 2acontrol | OR, 5.8 (95% CI, 1.2–28.2) [60]e |
Transfusion > 10 U PRBCs in the first 6 h and ED systolic BP < 70 mmHg | NR | 9 variablesf | INR > 1.5 at 6 h | OR, 0.48 (95% CI, 0.10–2.23) [50] |
Transfusion > 10 U PRBCs in the first 24 h and lowest temperature < 34 °C | 31 | ISS > 25, PRBCs transfused in 24 h, lowest systolic BP <70 mmHg, and pH <7.1 | PT & PTT > 2acontrol | OR, 8.7 (95% CI, 1.8–41.8) [60]e |
Transfusion > 10 U PRBCs in the first 6 h and ED temperature < 34 °C | NR | 9 variablesf | INR > 1.5 at 6 h | OR, 6.10 (95% CI, 1.54–24.19) [50] |
Transfusion > 10 U PRBCs in the first 24 h and lowest pH < 7.1 | 31 | ISS > 25, PRBCs transfused in 24 h, lowest systolic BP < 70 mmHg, and temperature < 34 °C | PT & PTT > 2acontrol | OR, 12.3 (95% CI, 2.4–64.0) [60]e |
Transfusion > 10 U PRBCs in the first 6 h and ED pH < 7.1 | NR | 9 variablesf | INR > 1.5 at 6 h | OR, 1.69 (95% CI, 0.56–5.08) [50] |
Degree of physiologic insult | ||||
Min temperature ≤ 33 °C | 100 | None | Survival | OR, 0.20 (p-value reported as NS) [63] |
Elevated max BD in the first 24 h in blunt trauma patients without TBI | NR | Age ≥ 55 yr | Mortality | OR per max BD ↑, 1.39 (95% CI, 1.35 to 1.41) [64] |
Elevated max BD in the first 24 h in penetrating trauma patients without TBI | NR | Age ≥ 55 yr | Mortality | OR per max BD ↑, 1.58 (95% CI, 1.44 to 1.75) [64] |
Elevated max BD in the first 24 h in blunt trauma patients with TBI | NR | Age ≥ 55 yr | Mortality | OR per max BD ↑, 1.25 (95% CI, 1.14 to 1.38) [64] |
Min pH ≤ 7.18 | 100 | None | Survival | OR, 0.17 (p < 0.05) [63] |
Miscellaneous | ||||
Transfusion ≥ 10 U PRBCs, lowest ED or intraoperative temperature ≤ 33 °C, pH ≤ 7.18, ED PT ≥ 16 s, or ED PTT ≥ 50 s | 100 | None | Survival | ↓ survival when 4–5 (0% vs. 82%; p < 0.04) or 2–3 (17% vs. 82%; p < 0.003) vs. 0–1 of these indications were present [63] |
A model including BD, penetrating MOI, TBI, age ≥ 55 yr, and an interaction between BD and penetrating MOI and BD and TBI. This model predicted that the BD for which the probability of survival was 75% was 15 mmol/L for young patients without TBI versus 8 mmol/L for patients aged < 55 yr with a TBI and older patients aged ≥ 55 yr | NR | BD, penetrating MOI, TBI, age ≥ 55 yr | 75% survival | Model Se, 71%; model Sp, 89% [64] |