Sierink Joanne C, Joosse Pieter, de Castro Steve Mm, Schep Niels Wl, Goslings J Carel
Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, Amsterdam AZ 1105, The Netherlands.
Int J Emerg Med. 2014 Jul 10;7:26. doi: 10.1186/s12245-014-0026-3. eCollection 2014.
In our level I trauma center, it is considered common practice to repeat blood haemoglobin measurements in patients within 2 h after admission. However, the rationale behind this procedure is elusive and can be considered labour-intensive, especially in patients in whom haemorrhaging is not to be expected. The aim of this study was to assess the value of the repeated Hb measurement (r-Hb) within 2 h in adult trauma patients without evidence of haemodynamic instability.
The local trauma registry was used to identify all trauma patients without evidence of haemodynamic instability from January 2009 to December 2010. Patients in whom no initial blood Hb measurement (i-Hb) was done on admission, referrals, and patients without risk for traumatic injuries or haemorrhage based upon mechanism of injury (e.g. inhalation or drowning injury) were excluded.
A total of 1,537 patients were included in the study, 1,246 of which did not present with signs of haemodynamic instability. Median Injury Severity Score (ISS) was 5 (interquartile range (IQR) 1 to 13), 22% of the patients were multitrauma patients (ISS > 15). A normal i-Hb was found in 914 patients (73%). Of the 914 patients with a normal i-Hb, 639 (70%) had a normal r-Hb, while in 127 patients (14%), an abnormal r-Hb was found. In none of these patients, the abnormal r-Hb led to new diagnoses. In 148 patients (16%), no repeated Hb measurement was done without clinical consequences.
We conclude that repeated blood Hb measurement within 2 h after admission in stable, adult trauma patients with a normal initial Hb concentration does not add value to a trauma patient's evaluation.
在我们的一级创伤中心，入院后2小时内对患者重复进行血红蛋白测量被视为常规做法。然而，这一程序背后的基本原理并不明确，而且可能被认为是劳动密集型的，尤其是在预计不会出血的患者中。本研究的目的是评估在无血流动力学不稳定证据的成年创伤患者中，入院后2小时内重复血红蛋白测量（r-Hb）的价值。
利用当地创伤登记系统，确定2009年1月至2010年12月期间所有无血流动力学不稳定证据的创伤患者。排除入院时未进行初始血红蛋白测量（i-Hb）的患者、转诊患者以及根据损伤机制（如吸入或溺水损伤）无创伤或出血风险的患者。
共有1537例患者纳入研究，其中1246例无血流动力学不稳定迹象。损伤严重度评分（ISS）中位数为5（四分位间距[IQR]为1至13），22%的患者为多发伤患者（ISS>15）。914例患者（73%）的i-Hb正常。在914例i-Hb正常的患者中，639例（70%）的r-Hb正常，而127例（14%）的r-Hb异常。在这些患者中，没有一例因r-Hb异常而得出新的诊断。148例患者（16%）未进行重复血红蛋白测量，但未产生临床后果。
我们得出结论，对于初始血红蛋白浓度正常的稳定成年创伤患者，入院后2小时内重复进行血红蛋白测量对创伤患者的评估没有附加价值。
