Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center, Cologne, Germany.
Resuscitation. 2013 Mar;84(3):309-13. doi: 10.1016/j.resuscitation.2012.07.012. Epub 2012 Jul 24.
The aim of this study was to validate the classification of hypovolaemic shock given by the Advanced Trauma Life Support (ATLS).
Patients derived from the TraumaRegister DGU(®) database between 2002 and 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.
36,504 patients were identified for further analysis. Only 3411 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.
This study indicates that the ATLS classification of hypovolaemic shock does not seem to reflect clinical reality accurately.
本研究旨在验证高级创伤生命支持（ATLS）所给出的低血容量性休克分类。
分析了 2002 年至 2010 年期间创伤登记数据库（TraumaRegister DGU®）中的患者。首先，根据 ATLS 将心率（HR）、收缩压（SBP）和格拉斯哥昏迷评分（GCS）的组合分配给低血容量性休克的四个类别。其次，根据 ATLS 分类，仅使用一个参数（HR、SBP 或 GCS）对患者进行分类，并评估这四个组中剩余两个参数的相应变化。还进行了人口统计学、损伤和治疗特征的分析。
确定了 36504 名患者进行进一步分析。只有 3411 名患者（9.3%）可以根据 ATLS 进行充分分类，而 33093 名患者不符合 ATLS 给出的所有三个标准的组合。当按 HR 分组时，仅与心动过速相关的 SBP 略有下降。GCS 中位数从 12 降至 3。当按 SBP 分组时，GCS 从 13 降至 3，而任何组中均未观察到相关的心动过速。GCS=15 的患者表现为正常血压和 HR 为 88/min，而 GCS<12 的患者表现为 SBP 略有降低（117mmHg），HR 未改变。
本研究表明，ATLS 对低血容量性休克的分类似乎不能准确反映临床实际情况。
