Top

European Journal of Trauma and Emergency Surgery

Published in:

Open Access 01-12-2017 | Original Article

Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members

Authors: S. A. I. Loggers, T. W. A. Koedam, G. F. Giannakopoulos, E. Vandewalle, M. Erwteman, W. P. Zuidema

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2017

Abstract

Introduction

Trauma is a great contributor to mortality worldwide. One of the challenges in trauma care is early identification and management of bleeding. The circulatory status of blunt trauma patients in the emergency room is evaluated using hemodynamic (HD) parameters. However, there is no consensus on which parameters to use. In this study, we evaluate the used terms and definitions in the literature for HD stability and compare those to the opinion of Dutch trauma team members.

Method

A systematic review was performed to collect the definitions used for HD stability. Studies describing the assessment and/or treatment of blunt trauma patients in the emergency room were included. In addition, an online survey was conducted amongst Dutch trauma team members.

Results

Out of a total of 222, 67 articles were found to be eligible for inclusion. HD stability was defined in 70% of these articles. The most used parameters were systolic blood pressure and heart rate. Besides the variety of parameters, a broad range of corresponding cut-off points is noted. Despite some common ground, high inter- and intra-variability is seen for the physicians that are part of the Dutch trauma teams.

Conclusion

All authors acknowledge HD stability as the most important factor in the assessment and management of blunt trauma patients. There is, however, no consensus in the literature as well as none-to-fair consensus amongst Dutch trauma team members in the definition of HD stability. A trauma team ready to co-operate with consensus-based opinions together with a valid scoring system is in our opinion the best method to assess and treat seriously injured trauma patients.

World Health Organization. Causes of death 2008 summary tables, Department, Health statistics and informatics. World Health Organization, Geneva, Switzerland; 2011. http://www.who.int/evidence/bod. Accessed 22 Mar 2016.

World Health Organization. Global Burden of disease 2004 update, Health statistics and informatics. World Health Organization, Geneva, Switzerland, 2011. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Accessed 22 Mar 2016.

American College of Surgeons. Advanced trauma life support for doctors. 8th ed. Chicago: American College of Surgeons; 2008.

Gaarder C, et al. Scandinavian guidelines—the massive bleeding patient. Scand J Surg. 2008;97:15–36.CrossRefPubMed

Johansson PI, et al. Effect of haemostatic control resuscitation on mortality in massively bleeding patients: a before and after study. Vox Sang. 2009;96:111–8.CrossRefPubMed

American College of Surgeons. Prehospital Trauma Life Support. 7th ed. St. Louis: Elsevier; 2011.

Guly HR, Bouamra O, Little R, Dark P, Coats T, Lecky FE, et al. Testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation. 2010;81:1142–7.CrossRefPubMed

Little RA, Kirkman E, Driscoll P, Hanson J, Mackway-Jones K. Preventable deaths after injury: why are the traditional ‘vital’ signs poor indicators of blood loss? J Accid Emerg Med. 1995;12:1–14.CrossRefPubMedPubMedCentral

Victorino GP, Battistella FD, Wisner DH. Does tachycardia correlate with hypotension after trauma? J Am Coll Surg. 2003;196:679–84.CrossRefPubMed

10.

Brasel KJ, Guse C, Gentilello LM, Nirula R. Heart rate: is it truly a vital sign? J Trauma. 2007;62:812–7.CrossRefPubMed

11.

Rady MY, Smithline HA, Blake H, Nowak R, Rivers E. A comparison of the shock index and conventional vital signs to identify acute, critical illness in the emergency department. Ann Emerg Med. 1994;24:685–90.CrossRefPubMed

12.

Luna GK, Eddy AC, Copass M. The sensitivity of vital signs in identifying major thoracoabdominal hemorrhage. Am J Surg. 1989;157:512–5.CrossRefPubMed

13.

Birkhahn RH, Gaeta TJ, Terry D, Bove JJ, Tloczkowski J. Shock index in diagnosing early acute hypovolemia. Am J Emerg Med. 2005;23(3):323–6.CrossRefPubMed

14.

Vandromme MJ, Griffin RL, Kerby JD, McGwin G, Rue LW, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011;70:384–8.CrossRefPubMed

15.

Cannon CM, Braxton CC, Kling-Smith M, Mahnken JD, Carlton E, Moncure M. Utility of the shock index in predicting mortality in traumatically injured patients. J Trauma. 2009;67:1426–30.CrossRefPubMed

16.

Ogura T, Lefor AT, Nakano M, Izawa Y, Morita H. Nonoperative management of hemodynamically unstable abdominal trauma patients with angioembolization and resuscitative endovascular balloon occlusion of the aorta. J Trauma Acute Care Surg. 2015;78(1):132–5.CrossRefPubMed

17.

Iqbal Y, Taj MN, Ahmed A, Rehman ZU, Akbar Z. Validity of the fast scan for diagnosis of intraabdominal injury in blunt abdominal trauma. J Ayub Med Coll Abbottabad. 2014;26(1):52–6.PubMed

18.

Li M, Yu WK, Wang XB, Ji W, Li JS, Li N. Non-operative management of isolated liver trauma. Hepatobiliary Pancreat Dis Int. 2014;13(5):545–50.CrossRefPubMed

19.

Olthof DC, Luitse JS, de Rooij PP, Leenen LP, Wendt KW, Bloemers FW, Goslings JC. Variation in treatment of blunt splenic injury in Dutch academic trauma centers. J Surg Res. 2015;194(1):233–8.CrossRefPubMed

20.

Asfar S, Khoursheed M, Al-Saleh M, Alfawaz AA, Farghaly MM, Nur AM, Liver Trauma Registry Group. Management of liver trauma in Kuwait. Med Princ Pract. 2014;23(2):160–6.CrossRefPubMedPubMedCentral

21.

Toth L, King KL, McGrath B, Balogh ZJ. Factors associated with pelvic fracture-related arterial bleeding during trauma resuscitation: a prospective clinical study. J Orthop Trauma. 2014;28(9):489–95.CrossRefPubMedPubMedCentral

22.

Katsura M, Yamazaki S, Fukuma S, Matsushima K, Yamashiro T, Fukuhara S. Comparison between laparotomy first versus angiographic embolization first in patients with pelvic fracture and hemoperitoneum: a nationwide observational study from the Japan Trauma Data Bank. Scand J Trauma Resusc Emerg Med. 2013;3(21):82.CrossRef

23.

Figler BD, Malaeb BS, Voelzke B, Smith T, Wessells H. External validation of a substratification of the American Association for the Surgery of Trauma renal injury scale for grade 4 injuries. J Am Coll Surg. 2013;217(5):924–8.CrossRefPubMed

24.

van der Wilden GM, Velmahos GC, Joseph DK, Jacobs L, Debusk MG. Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma. JAMA Surg. 2013;148(10):924–31.CrossRefPubMed

25.

Huber-Wagner S, Biberthaler P, Häberle S, Wierer M, Dobritz M, Rummeny E, van Griensven M, Kanz KG, Lefering R, TraumaRegister DGU. Whole-body CT in haemodynamically unstable severely injured patients–a retrospective, multicentre study. PLoS One. 2013;8(7):e68880.CrossRefPubMedPubMedCentral

26.

Bar-Or D, Salottolo KM, Orlando A, Mains CW, Bourg P, Offner PJ. Association between a geriatric trauma resuscitation protocol using venous lactate measurements and early trauma surgeon involvement and mortality risk. J Am Geriatr Soc. 2013;61(8):1358–64.CrossRefPubMed

27.

Purvis D, Aldaghlas T, Trickey AW, Rizzo A, Sikdar S. A novel decision tree approach based on transcranial doppler sonography to screen for blunt cervical vascular injuries. J Ultrasound Med. 2013;32:1023–31.CrossRefPubMed

28.

Di Eusanio M, Folesani G, Berretta P, Petridis FD, Pantaleo A, Di Bartolomeo R, et al. Delayed management of blunt traumatic aortic injury: open surgical versus endovascular repair. Ann Thorac Surg. 2013;95:1591–7.CrossRefPubMed

29.

Olthof DC, Sierink JC, van Delden OM, Luitse JSK, Goslings JC. Time to intervention in patients with splenic injury in a Dutch level 1 trauma centre. Inj Int J Care Inj. 2014;45:95–100.CrossRef

30.

Myint KS, French S, Williams-Johnson J, Williams E, Johnson P, Reid MO, Gordon-Strachan G. Role of routine chest radiographs in the evaluation of patients with stable blunt chest trauma–a prospective analysis. West Indian Med J. 2012;61(1):64–72.PubMed

31.

van der Wilden GM, Velmahos GC, Joseph AK, Jacobs L, DeBusk MG, de Moya MA, et al. Successful nonoperative management of the most severe blunt renal injuries. JAMA Surg. 2013;148(10):924–31.CrossRefPubMed

32.

Yuan KC, Wong YC, Lin BC, Kang SC, Liu EH, Hsu YP. Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma. Scand J Trauma Resusc Emerg Med. 2012;7(20):46.CrossRef

33.

Bhullar IS, Frykberg ER, Siragusa D, Chesire D, Paul J, Kerwin AJ, et al. Selective angio graphic embolization of blunt splenic traumatic injuries in adults decreases failure rate of nonoperative management. J Trauma. 2012;72(5):1127–34.

34.

Fu CY, Hsieh CH, Shih CH, Wang YC, Chen RJ, Huang HC, Huang JC, Wu SC, Tsuo HC, Tung HJ. Selective computed tomography and angioembolization provide benefits in the management of patients with concomitant unstable hemodynamics and negative sonography results. World J Surg. 2012;36(4):819–25.CrossRefPubMed

35.

Barleben A, Jafari F, Rose J, Dolich M, Malinoski D, Cinat M, et al. Implementation of a cost-saving algorithm for pelvic radiographs in blunt trauma patients. J Trauma. 2011;71(3):582–4.CrossRefPubMed

36.

Kawahito K, Adachi H. Hypothermic circulatory arrest for acute traumatic aortic rupture associated with shock. Gen Thorac Cardiovasc Surg. 2011;59(7):472–6.CrossRefPubMed

37.

van der Vlies CH, Olthof DC, van Delden OM, Ponsen KJ, de la Rosette JJMCH, Goslings JC, et al. Management of blunt renal injury in a level 1 trauma centre in view of the European guidelines. Inj Int J Care Inj. 2012;43:1816–20.CrossRef

38.

Tan ECTH, van Stigt SFL, van Vugt AB. Effect of a new pelvic stabilizer (T-POD1) on reduction of pelvic volume and haemodynamic stability in unstable pelvic fractures. Inj Int J Care Inj. 2010;41:1239–43.CrossRef

39.

Franco F, Monaco D, Volpi A, Marcato C, Larini P, Rossi C. The role of arterial embolization in blunt splenic injury. Radiol Med. 2011;116(3):454–65.CrossRefPubMed

40.

Matsumoto S, Sekine K, Yamazaki M, Sasao K, Funabiki T, Shimizu M, Yoshii H, Kishikawa M, Kitano M. Predictive value of a flat inferior vena cava on initial computed tomography for hemodynamic deterioration in patients with blunt torso trauma. J Trauma. 2010;69(6):1398–402.CrossRefPubMed

41.

Wang YC, Fu CY, Chen YF, Hsieh CH, Wu SC, Yeh CC. Role of arterial embolization on blunt hepatic trauma patients with type I contrast extravasation. Am J Emerg Med. 2011;29:1147–51.CrossRefPubMed

42.

Ball CG, Wyrzykowski AD, Kirkpatrick AW, Dente CJ, Nicholas JM, Salomone JP, Rozycki GS, Kortbeek JB, Feliciano DV. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length. Can J Surg. 2010;53(3):184–8.PubMedPubMedCentral

43.

DuBose J, Inaba K, Barmparas G, Teixeira PG, Schnüriger B, Talving P, Salim A, Demetriades D. Bilateral internal iliac artery ligation as a damage control approach in massive retroperitoneal bleeding after pelvic fracture. J Trauma. 2010;69(6):1507–14.CrossRefPubMed

44.

Tan KK, Yan ZY, Vijayan A, Chiu MT. Management of diaphragmatic rupture from blunt trauma. Singap Med J. 2009;50(12):1150–3.

45.

Morozumi J, Homma H, Ohta S, Noda M, Oda J, Yukioka T, et al. Impact of mobile angiography in the emergency department for controlling pelvic fracture hemorrhage with hemodynamic instability. J Trauma. 2010;68(1):90–5.CrossRefPubMed

46.

Shirazi M, Sefidbakht S, Jahanabadi Z, Asadolahpour A, Afrasiabi MA. Is early reimaging CT scan necessary in patients with grades III and IV renal trauma under conservative treatment? J Trauma. 2010;68(1):9–12.CrossRefPubMed

47.

Tan KK, Chan DX, Vijayan A, Chiu MT. Management of pancreatic injuries after blunt abdominal trauma. Experience at a single institution. JOP. 2009;10(6):657–63.PubMed

48.

Misselbeck TS, Teicher EJ, Cipolle MD, Pasquale MD, Shah KT, Badellino MM, et al. Hepatic angioembolization in trauma patients: indications and complications. J Trauma. 2009;67(4):769–73.CrossRefPubMed

49.

Fu CY, Wu SC, Chen RJ, Wang YC, Chung PK, Huang HC, et al. Evaluation of pelvic fracture stability and the need for angioembolization: pelvic instabilities on plain film have an increased probability of requiring angioembolization. Am J Emerg Med. 2009;27:792–6.CrossRefPubMed

50.

Ball CG, Rozycki GS, Feliciano DV. Upper extremity amputations after motor vehicle rollovers. J Trauma. 2009;67(2):410–2.CrossRefPubMed

51.

Pata G, Casella C, Di Betta E, Grazioli L, Salerni B. Extension of nonoperative management of blunt pancreatic trauma to include grade III injuries: a safety analysis. World J Surg. 2009;33:1611–7.CrossRefPubMed

52.

Giannopoulos GA, Katsoulis IE, Tzanakis NE, Patsaouras PA, Digalakis MK. Non-operative management of blunt abdominal trauma. Is it safe and feasible in a district general hospital? Scand J Trauma Resusc Emerg Med. 2009;17:22.CrossRefPubMedPubMedCentral

53.

Geisbüsch P, Leszczynsky M, Kotelis D, Hyhlik-Dürr A, Weber TF, Böckler D. Open versus endovascular repair of acute aortic transections—a non-randomized single-center analysis. Langenbecks Arch Surg. 2009;394:1101–7.CrossRefPubMed

54.

Gauer JM, Gerber-Paulet S, Seiler C, Schweizer WP. Twenty years of splenic preservation in trauma: lower early infection rate than in splenectomy. World J Surg. 2008;32(12):2730–5.CrossRefPubMed

55.

Verbeek D, Sugrue M, Balogh Z, Cass D, Civil I, Wills V, et al. Acute management of hemodynamically unstable pelvic trauma patients: time for a change? World J Surg. 2008;32:1874–82.CrossRefPubMed

56.

Monnin V, Sengel C, Thony F, Bricault I, Voirin D, Ferretti G, et al. Place of arterial embolization in severe blunt hepatic trauma: a multidisciplinary approach. Cardiovasc Interv Radiol. 2008;31:875–82.CrossRef

57.

Bala M, Edden Y, Mintz Y, Kisselgoff D, Gercenstein I, Almogy G, et al. Blunt splenic trauma: predictors for successful non-operative management. IMAJ. 2007;9:857–61.PubMed

58.

Lin WC, Chen YF, Lin CH, Tzeng YH, Chiang HJ, Ho YJ, Shen WC, Chen JH. Emergent transcatheter arterial embolization in hemodynamically unstable patients with blunt splenic injury. Acad Radiol. 2008;15(2):201–8.CrossRefPubMed

59.

Friese RS, Malekzadeh S, Shafi S, Gentilello LM, Starr A. Abdominal ultrasound is an unreliable modality for the detection of hemoperitoneum in patients with pelvic fracture. J Trauma. 2007;63(1):97–102.CrossRefPubMed

60.

Kuncir EJ, Velmahos GC. Diagnostic peritoneal aspiration–the foster child of DPL: a prospective observational study. Int J Surg. 2007;5(3):167–71 (Epub 2006 Aug 14).CrossRefPubMed

61.

Tötterman A, Madsen JE, Skaga NO, Røise O. Extraperitoneal pelvic packing: a salvage procedure to control massive traumatic pelvic hemorrhage. J Trauma. 2007;62(4):843–52.CrossRefPubMed

62.

Zheng YX, Chen L, Tao SF, Song P, Xu SM. Diagnosis and management of colonic injuries following blunt trauma. World J Gastroenterol. 2007;13(4):633–6.CrossRefPubMedPubMedCentral

63.

Cook J, Salerno C, Krishnadasan B, Nicholls S, Meissner M, Karmy-Jones R. The effect of changing presentation and management on the outcome of blunt rupture of the thoracic aorta. J Thorac Cardiovasc Surg. 2006;131(3):594–600.CrossRefPubMed

64.

Gezen FC, Cinçin TG, Oncel M, Vural S, Erdemir A, Dalkiliç G, Menteş C, Tüzün B. Noninvasive management strategy in hemodynamically unstable patients with blunt trauma. Ulus Travma Acil Cerrahi Derg. 2006;12(1):43–50.PubMed

65.

Fang JF, Wong YC, Lin BC, Hsu YP, Chen MF. Usefulness of multidetector computed tomography for the initial assessment of blunt abdominal trauma patients. World J Surg. 2006;30:176–82.CrossRefPubMed

66.

Stampfl P, Greitbauer M, Zimpfer D, Fleck T, Schoder M, Czerny M, et al. Mid-term results of conservative, conventional and endovascular treatment for acute traumatic aortic lesions. Eur J Vasc Endovasc Surg. 2006;31:475–80.CrossRefPubMed

67.

Christmas AB, Wilson AK, Manning B, Franklin GA, Miller FB, Rodriguez JL, et al. Selective management of blunt hepatic injuries including nonoperative management is a safe and effective strategy. Surgery. 2005;138(4):606–11.CrossRefPubMed

68.

Peitzman AB, Harbrecht BG, Rivera L, Heil B, The Eastern Association for the Surgery of Trauma Multi institutional Trials Workgroup. Failure of observation of blunt splenic injury in adults: variability in practice and adverse consequences. J Am Coll Surg. 2005;201(2):179–87.CrossRefPubMed

69.

Balogh Z, Caldwell E, Heetveld M, D’Amours S, Schlaphoff G, Sugrue M, et al. Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference? J Trauma. 2005;58(4):778–82.CrossRefPubMed

70.

Kataoka Y, Maekawa K, Nishimaki H, Yamamoto S, Soma K. Iliac vein injuries in hemodynamically unstable patients with pelvic fracture caused by blunt trauma. J Trauma. 2005;58(4):704–8 discussion 708–10.CrossRefPubMed

71.

Mitsuhide K, Junichi S, Atsushi N, Masakazu D, Shinobu H, Hiroshi Y. Computed tomographic scanning and selective laparoscopy in the diagnosis of blunt bowel injury: a prospective study. J Trauma. 2005;58(4):696–703.CrossRefPubMed

72.

Hagiwara A, Fukushima H, Murata A, Matsuda H, Shimazaki S. Blunt splenic injury: usefulness of transcatheter arterial embolization in patients with a transient response to fluid resuscitation. Radiology. 2005;235(1):57–64.CrossRefPubMed

73.

Suzuki T, Moirmura N, Kawai K, Sugiyama M. Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma. Injury. 2005;36(1):151–9.CrossRefPubMed

74.

Smithson L, Morrell J, Kowalik U, Flynn W, Guo WA. Correlation of computed tomographic signs of hypoperfusion and clinical hypoperfusion in adult blunt traumaJournal of Trauma and Acute Care Surgery. 2015;78(6):1162–7.

75.

Fu CY, Yang SJ, Liao CH, Lin BC, Kang SC, Wang SY, Yuan KC, Ouyang CH, Hsu YP. Hypotension does not always make computed tomography scans unfeasible in the management of blunt abdominal trauma patients. Injury. 2015;46(1):29–34.CrossRefPubMed

76.

Tugnoli G, Bianchi E, Biscardi A, Coniglio C, Isceri S, Simonetti L, Gordini G, Di Saverio S. Nonoperative management of blunt splenic injury in adults: there is (still) a long way to go. The results of the Bologna-Maggiore Hospital trauma center experience and development of a clinical algorithm. Surg Today. 2015;45(10):1210–7.CrossRefPubMed

77.

Liu PP, Liu HT, Hsieh TM, Huang CY, Ko SF. Nonsurgical management of delayed splenic rupture after blunt trauma. J Trauma. 2012;72(4):1019–23.

78.

Becker A, Lin G, McKenney MG, Marttos A, Schulman CI. Is the FAST exam reliable in severely injured patients? Injury. 2010;41(5):479–83.CrossRefPubMed

79.

Salim A, Teixeira PGR, DuBose J, Ottochian M, Inaba K, Margulies DR, Demetriades D. Predictors of positive angiography in pelvic fractures: a prospective study. J Am Coll Surg. 2008;207(5):656–62.CrossRefPubMed

80.

Mizushima Y, Tohira H, Mizobata Y, Matsuoka T, Yokota J. Fluid resuscitation of trauma patients: how fast is the optimal rate? Am J Emerg Med. 2005;23:833–7.CrossRefPubMed

81.

Vécsei V, Arbes S, Aldrian S, Nau T. Chest injuries in polytrauma. Eur J Trauma. 2005;31(3):239–43.CrossRef

82.

Olthof DC, van der Vlies CH, Joosse P, van Delden OM, Jurkovich GJ, Goslings JC. Consensus strategies for the nonoperative management of patients with blunt splenic injury: a Delphi study. J Trauma Acute Care Surg. 2013;74(6):1567–74.CrossRefPubMed

83.

Mutschler M, Hoffmann M, Wölfl C, Münzberg M, Schipper I, Paffrath T, Bouillon B, Maegele M. Is the ATLS classification of hypovolaemic shock appreciated in daily trauma care? An online-survey among 383 ATLS course directors and instructors. Emerg Med J. 2015;32(2):134–7.CrossRefPubMed

84.

Bland RD. Shoemaker WC, Abraham E, Cobo JC. Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients. Crit Care Med. 1985;13(2):85–90.CrossRefPubMed

85.

Pommerening MJ, Goodman MD, Holcomb JB, Wade CE, Fox EE, del Junco DJ, Brasel KJ, Bulger EM, Cohen MJ, Alarcon LH, Schreiber MA, Myers JG, Phelan HA, Muskat P, Rahbar M, Cotton BA. Clinical gestalt and the prediction of massive transfusion after trauma. Inj Int J Care Inj. 2015;46:807–13.CrossRef

86.

Meredith JW, Young JS, Bowling J, Roboussin D. Nonoperative management of blunt hepatic trauma: the exception or the rule? J Trauma. 1994;36(4):529–35.CrossRefPubMed

87.

Moore FA, Davis JW, Moore EE, Cocanour CS, West MA, McIntyre MC. Western Trauma Association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65(5):1007–11.CrossRefPubMed

88.

Yucel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma Associated Severe Hemorrhage (TAS)-score; probability of massive transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma. 2006;60:1228–36.CrossRefPubMed

89.

Numez TC, Voskresensky IV, Dossett LA, Shimall R, Dutton WD, Cotton BA. Early prediction of massive transfusion in trauma simple as ABC (assessment of blood consumption). J trauma. 2009;66:346–52 19–20.CrossRef

90.

Callcut RA, Cripps MW, Nelson MF, Conroy AS, Robinson BB, Cohen MJ. The massive transfusion score as a decision aid for resuscitation: learning when to turn the massive transfusion protocol on and off. J Trauma Acute Care Surg. 2016;80(3):450–6.CrossRefPubMedPubMedCentral

91.

Brockamp T, Nienaber U, Mutschler M, Wafaisade A, Peiniger S, Lefering R, Bouillon B, Maegele M, Dgu T. Predicting on-going hemorrhage and transfusion requirement after severe trauma: a validation of six scoring systems and algorithms on the TraumaRegister DGU(R). Crit Care. 2012;16:R129.CrossRefPubMedPubMedCentral

92.

Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, Bouillon B, Maegele M, TraumaRegister DGU. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU^®. Crit Care. 2013;17(2):R42.CrossRefPubMedPubMedCentral

93.

Joseph B, Haider A, Ibraheem K, Kulvatunyou N, Tang A, Azim A, O’keeffe T, Griess L, Vercruysse G, Rhee P. Revitalizing vital signs; the role of Delta Shock Index. Shock. 2016;46(3 Suppl 1):50–4.

Title: Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members
Authors: S. A. I. Loggers
T. W. A. Koedam
G. F. Giannakopoulos
E. Vandewalle
M. Erwteman
W. P. Zuidema
Publication date: 01-12-2017
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 6/2017
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-016-0744-8

At a glance: The STEP trials

Springer Medicine

Definition of hemodynamic stability in blunt trauma patients: a systematic review and assessment amongst Dutch trauma team members

Abstract

Introduction

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2017

Acute pancreatitis: is early CT necessary?

Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: a descriptive study

β-Blocker after severe traumatic brain injury is associated with better long-term functional outcome: a matched case control study

Trauma to the bladder and ureter: a review of diagnosis, management, and prognosis

Two injection digital block versus single subcutaneous palmar injection block for finger lacerations

The impact of measurement of respiratory quotient by indirect calorimetry on the achievement of nitrogen balance in patients with severe traumatic brain injury