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. 2025 Jan 14;51(1):16.
doi: 10.1007/s00068-024-02713-6.

Ionised calcium levels during trauma resuscitation in predicting outcomes-a prospective cohort study

Ramesh Vaidyanathan  1 , Preksha Rani  1 , Shrikanth Manwatkar  1 , J K Singh  1 , Dinesh Gora  1 , Pranabh Kushwaha  1 , Pratyusha Priyadarshini  1 , Dinesh Bagaria  1 , Narendra Choudhary  1 , Junaid Alam  1 , Arul Selvi  2 , Anand Kumar  2 , Kapil Dev Soni  3 , Sushma Sagar  1 , Subodh Kumar  1 , Amit Gupta  1 , Biplab Mishra  1 , Abhinav Kumar  4 , Mahroof Khan  5
Affiliations

Ionised calcium levels during trauma resuscitation in predicting outcomes-a prospective cohort study

Ramesh Vaidyanathan et al. Eur J Trauma Emerg Surg. .

Abstract

Background: Haemorrhage remains the leading cause of preventable mortality following trauma, often aggravated by the acidosis, hypothermia and coagulopathy-the lethal triad of trauma. However, the impact of trauma-induced hypocalcemia on the haemorrhage remains unclear. It is intuitive to consider perturbations of ionised calcium early during trauma resuscitation in acutely injured patients given its pathophysiological significance for an improved outcome. Thus, we conducted a prospective study to analyse the role of ionized calcium ion levels during trauma resuscitation and its association with the need for blood transfusion(s) requirement and mortality.

Methods: A prospective study was conducted on acutely injured patients with haemorrhage getting admitted to a Level 1 trauma center in India between September 2020 and June 2022. Ionised calcium was measured on arrival, after 6 h, and on day two of the injury to assess the prevalence. The amount of blood transfusion received by the patient was noted along with other demographic and in-hospital details. The association of hypocalcemia with blood transfusion and mortality was also evaluated.

Results: Of the 1961 patients screened for eligibility, 200 patients were recruited and analysed. 72.5% of patients were hypocalcaemic on emergency department (ED) admission. Ionized hypocalcaemia was significantly associated with the need for blood transfusion(s) (p-value < 0.01). A significant association was also noted between ionized hypocalcaemia and mortality (p-value: 0.0085). On the univariate and multivariable analysis, ionized hypocalcaemia was a significant predictor of mortality.

Conclusions: Ionized hypocalcaemia is widely prevalent among acutely injured. Trauma-induced hypocalcaemia at admission is associated with increased need for blood transfusions and increased mortality.

Keywords: Blood transfusion; Haemorrhage; Ionised calcium; Mortality; Trauma resuscitation; Trauma-induced hypocalcaemia.

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Conflict of interest statement

Declarations. Conflict of interest: None.

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