Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2012  |  Volume : 5  |  Issue : 3  |  Page : 233-237

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


1 Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham B15 2SQ, United Kingdom
2 Department of General Surgery, Glasgow Royal Infirmary, 84-108 Castle Street, Glasgow G4 0SF, United Kingdom
3 Surgical Department, 144 Parachute Medical Squadron, 16 Air Assault Medical Regiment, Royal Army Medical Corps, Cholchester, Essex, CO2 7UT, United Kingdom

Correspondence Address:
Jonathan J Morrison
Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham B15 2SQ
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.99690

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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.


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