Document Detail

Testing the validity of the ATLS classification of hypovolaemic shock.
MedLine Citation:
PMID:  20619954     Owner:  NLM     Status:  MEDLINE    
AIM: The Advanced Trauma Life Support system classifies the severity of shock. The aim of this study is to test the validity of this classification.
METHODS: Admission physiology, injury and outcome variables from adult injured patients presenting to hospitals in England and Wales between 1989 and 2007 and stored on the Trauma Audit and Research Network (TARN) database, were studied. Patients were divided into groups representing the four ATLS classes of shock, based on heart rate (HR) systolic blood pressure (SBP), respiratory rate (RR) and Glasgow Coma Score (GCS). The relationships between variables were examined by classifying the cohort by each recorded variable in turn and deriving the median and interquartile range (IQR) of the remaining three variables. Patients with penetrating trauma and major injuries were examined in sub-group analyses.
RESULTS: In blunt trauma patients grouped by HR, the median SBP decreased from 128 mmHg in patients with HR<100 BPM to 114 mmHg in those with HR>140 BPM. The median RR increased from 18 to 22 bpm and the GCS reduced from 15 to 14. The median HR in hypotensive patients was 88 BPM compared to 83 BPM in normotensive patients and the RR was the same. When grouped by RR, the HR increased with increasing RR but there were no changes in SBP.
CONCLUSION: In trauma patients there is an inter-relationship between derangements of HR, SBP, RR and GCS but not to the same degree as that suggested by the ATLS classification of shock.
H R Guly; O Bouamra; R Little; P Dark; T Coats; P Driscoll; F E Lecky
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article    
Journal Detail:
Title:  Resuscitation     Volume:  81     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-24     Completed Date:  2010-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  1142-7     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
Derriford Hospital, Emergency Department, Derriford Rd, Plymouth, Devon PL6 8DH, UK.
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MeSH Terms
Blood Pressure
Glasgow Coma Scale
Heart Rate
Hypotension / etiology,  physiopathology
Life Support Care*
Middle Aged
Reproducibility of Results
Respiratory Rate
Shock / classification*,  etiology*,  physiopathology
Trauma Severity Indices
Wounds and Injuries / complications*
Wounds, Nonpenetrating / complications
Wounds, Penetrating / complications
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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