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

dBackground: Severe truncal multi trauma patients often develop coagulopath y, acidosis and hypothermia that makes major reparative trauma surgery dang erous. It was aimed to try to develop physiological indicators that would p redict a poor outcome when conventional reparative surgery was applied. The se indicators may help in the decision to switch from conventional reparati ve 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 mul tivisceral trauma (Injury Severity Score (ISS) > 35) who were admitted to t he intensive care unit at Waikato Hospital and who underwent conventional r eparative surgery. Results: Survival was strongly associated with base deficit (BD), core temp erature and ISS. Using multiple logistic regression on these indices. outco me 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 m oderate core temperature < 35.5 degrees C, and a ED of > 5 mEq/L were stron g predictors of death if conventional reparative surgery was practised. Conclusions: At the above mentioned levels of physiological compromise, pat ient survival after conventional trauma surgery can be predicted to be very unlikely. Damage-control measures would be worth attempting.