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. 2012 Jul;5(3):233-7.
doi: 10.4103/0974-2700.99690.

Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma

Jonathan J Morrison  1 , Euan J Dickson, Jan O Jansen, Mark J Midwinter
Affiliations

Utility of admission physiology in the surgical triage of isolated ballistic battlefield torso trauma

Jonathan J Morrison et al. J Emerg Trauma Shock. 2012 Jul.

Abstract

Background: An assessment of hemodynamic stability is central to surgical decision-making in the management of battlefield ballistic torso trauma (BBTT).

Aims: To analyse the utility of admission physiological parameters in characterising hemodynamic stability.

Settings and design: A retrospective analysis of consecutive admissions, with BBTT, to forward surgical facility in Afghanistan.

Materials and methods: The cohorts' admission physiology, need for operative intervention, and mortality data were collected retrospectively. The cohort was divided into patients requiring surgery for Life-Threatening Torso Hemorrhage (LTTH) and those not requiring immediate surgery (non-LTTH).

Statistical analysis: Parameters were compared using two sample t tests, Mann-Whitney, Fisher's exact, and Chi-square tests. Receiver operator characteristic curves were used to identify significant parameters and determine optimum cut-off values.

Results: A total of 103 patients with isolated BBTT were identified: 44 in the LTTH group and 59 in the non-LTTH group. The mean New Injury Severity Score ± Standard Deviation (NISS±SD) was 28±14 and 13±12, respectively. The heart rate, systolic blood pressure (SBP), pulse pressure, shock index (SI=heart rate/SBP) and base excess were analysed. SI correlated best with the need for surgical torso hemorrhage control, P<0.05. An optimal cut-off of 0.9 was identified, producing a positive and negative predictive value of 81% and 82%, respectively.

Conclusions: Shock index (SI) is a useful parameter for helping military surgeons triage BBTT, identifying patients requiring operative torso hemorrhage control. SI performance requires a normal physiological response to hypovolemia, and thus should always be considered in clinical context.

Keywords: Battlefield torso trauma; shock index; trauma surgery; triage.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of patient selection
Figure 2
Figure 2
The Receiver operator characteristic curve for Shock Index predicting torso hemorrhage
Figure 3
Figure 3
Decision plot of predictive value per SI cut-off value
See this image and copyright information in PMC

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