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A critical reappraisal of the ATLS classification of hypovolaemic shock: Does it really reflect clinical reality?
MedLine Citation:
PMID:  22835498     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIM: The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS). METHODS: Patients derived from the TraumaRegister DGU® database between 2002-2010 were analyzed. First, patients were allocated into the four classes of hypovolaemic shock by matching the combination of heart rate (HR), systolic blood pressure (SBP) and Glasgow Coma Scale (GCS) according to ATLS. Second, patients were classified by only one parameter (HR, SBP or GCS) according to the ATLS classification and the corresponding changes of the remaining two parameters were assessed within these four groups. Analyses of demographic, injury and therapy characteristics were performed as well. RESULTS: 36 504 patients were indentified for further analysis. Only 3 411 patients (9,3%) could be adequately classified according to ATLS, whereas 33 093 did not match the combination of all three criteria given by ATLS. When patients were grouped by HR, there was only a slight reduction of SBP associated with tachycardia. The median GCS declined from 12 to 3. When grouped by SBP, GCS dropped from 13 to 3 while there was no relevant tachycardia observed in any group. Patients with a GCS=15 presented normotensive and with a HR of 88/min, whereas patients with a GCS <12 showed a slight reduced SBP of 117mmHg and HR was unaltered. CONCLUSION: This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately.
Authors:
M Mutschler; U Nienaber; T Brockamp; A Wafaisade; H Wyen; S Peiniger; T Paffrath; B Bouillon; M Maegele
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-23
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ireland Ltd.
Affiliation:
Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), Cologne, Germany.
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