Base deficit development and its prognostic significance in posttrauma critical illness: An analysis by the trauma registry of the Deutsche Gesellschaft fur Unfallchirurgie

This prospective, multi-center, observational study of 2069 multiple trauma patients evaluated the prognostic significance of the posttrauma base defi cit (BD) on hospital and intensive care unit (ICU) admission to hemodynamic changes, volume and transfusion requirements, lactate and coagulation, as well as mortality. Furthermore, the importance of the ED development throug hout a patient's course of critical illness from the time of injury to ICU admission is analyzed as a prognostic factor for fatal outcome. The data we re obtained by the trauma registry of the 'Deutsche Gesellschaft fiir Unfal lchirurgie.' The patients were subdivided into five categories of increasin g ED values on hospital and ICU admission: Category I, ED less than or equa l to -2; Category II, -2 < ED <less than or equal to> 2; Category III, 2 < ED <less than or equal to> 6; Category IV, 6 < ED <less than or equal to> 1 0; and Category V, ED > 10. A statistical analysis was performed by means o f the ANOVA and chi-square tests. In 1264 (61.1%) of 2069 multiple trauma p atients (age 39 +/- 19 years, 70.0% males, injury severity score 22 +/- 13, 18.6% mortality), the ED was documented on hospital and in 1536 (74.2%) pa tients on ICU admission. At both points in time, an increase in the ED cate gory was associated with a significant decrease in systolic blood pressure and prothrombin time as well as increases in heart rate, lactate level and mortality (P < 0.0001). Also transfusion requirements (Category I: 4.5 +/- 7.7 and Category V: 13.7 +/- 13.0 packed red blood cells) increased signifi cantly on hospital admission (P <less than> 0.0001) with a worsening in the ED category. Mortality increased significantly (P < 0.0001) with a worseni ng of ED from hospital to ICU admission (from a mortality of 13% in patient s with a hospital and an ICU admission ED of <6 to 45% in patients with a h ospital and an ICU admission ED of >6). These data show that the base defic it is an early available important indicator to identify trauma patients wi th hemodynamic instability, high transfusion requirements, metabolic and co agulatory decompensation, as well as a high probability of death, The base deficit development may help to guide an early and aggressive therapy for t he trauma/hemorrhage induced tissue hypoxia.