Early physiologic predictors of injury severity and death in blunt multiple trauma

Immediate, accurate evaluation of blunt trauma hepatic injury (BTHI, traumatic injury to the liver) is essential for establishing a patient's prognosis. Initial physiologic and biochemical variables in 185 patients with BTHI were used to develop predictors of injury severity and death. The model, which uses an anatomic scoring system known as the Injury Severity Score (ISS), and physiologic and neurologic measurements taken upon hospital admission and during the next 72 hours, is explained and evaluated. Injuries were the result of automobile accidents (51 percent), motorcycle accidents (11 percent), pedestrian-automobile contact (8 percent), falls (16 percent), and crush (5 percent). The model was then tested on another group of 323 patients with multiple trauma injuries, including BTHI. Overall, the pattern of internal injuries and their consequences for volume loss (blood and fluid loss), including shock, and the degree of neurologic impairment were the most important predictors of death. Admission base excess (BEA, an indicator of the alkalinity of the blood and body fluids) and the Glasgow Coma Score (GCS, a measurement of neurologic function) were the best predictors of a patient's probability of death. Careful, in-depth analyses are provided of the importance of cardiorespiratory, metabolic, and hematologic (blood) and coagulation factors for outcome. The value of physiologic parameters measured on admission, such as the ISS and plasma lactate levels (an indicator of injury), is carefully assessed. Other models that predict mortality after BTHI are evaluated. Blunt multiple trauma is beginning to be recognized as an important cause of death, and patient evaluation should distinguish between this form of injury and penetrating injury. (Consumer Summary produced by Reliance Medical Information, Inc.)