Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey.
Eskisehir Osmangazi University Medical Center, Department of Radiology, Eskisehir, Turkey.
Prehosp Disaster Med. 2021 Aug;36(4):414-420. doi: 10.1017/S1049023X21000418. Epub 2021 May 6.
Shock is the leading cause of death in multi-trauma patients and must be detected at an early stage to improve prognosis. Many parameters are used to predict clinical condition and outcome in trauma. Computed tomography (CT) signs of hypovolemic shock in trauma patients are not clear yet, requiring further research. The flatness index of inferior vena cava (IVC) is a helpful method for this purpose.
This is a prospective, cross-sectional study which included adult multi-trauma patients (>18 years) who were admitted to the emergency department (ED) and underwent a thoraco-abdominal CT from 2017 through 2018. The main objective of this study was to investigate whether the flatness index of IVC can be used to determine the hypovolemic shock at an early stage in multi-trauma patients, and to establish its relations with shock parameters. The patients' demographic features, trauma mechanisms, vitals, laboratory values, shock parameters, and clinical outcome within 24 hours of admission were recorded.
Total of 327 (229 males with an average age of 40.9 [SD = 7.93]) patients were included in the study. There was no significant difference in the flatness index of IVC within genders (P = .134) and trauma mechanisms (P = .701); however, the flatness index of IVC was significantly higher in hypotensive (systolic blood pressure [SBP] ≤90 mmHg and/or diastolic blood pressure [DBP] ≤60 mmHg; P = .015 and P = .019), tachycardic (P = .049), and hypoxic (SpO2 ≤%94; P <.001) patients. The flatness index of IVC was also higher in patients with lactate ≥ 2mmol/l (P = .043) and patients with Class III hemorrhage (P = .003). A positive correlation was determined between lactate level and the flatness index of IVC; a negative correlation was found between Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) with the flatness index of IVC (for each of them, P <.05).
The flatness index of IVC may be a useful method to determine the hypovolemic shock at an early stage in multi-trauma patients.
在多发创伤患者中，休克是导致死亡的主要原因，必须尽早发现，以改善预后。有许多参数可用于预测创伤患者的临床状况和结局。创伤患者低血容量性休克的 CT 征象尚不清楚，需要进一步研究。下腔静脉（IVC）平坦指数是一种有用的方法。
这是一项前瞻性、横断面研究，纳入了 2017 年至 2018 年期间因多发伤入住急诊科并接受胸腹部 CT 检查的成年多发伤患者（>18 岁）。本研究的主要目的是探讨 IVC 平坦指数是否可用于早期确定多发伤患者的低血容量性休克，并确定其与休克参数的关系。记录患者的人口统计学特征、创伤机制、生命体征、实验室值、休克参数和入院后 24 小时内的临床转归。
共纳入 327 例（229 例男性，平均年龄 40.9 [标准差=7.93]）患者。IVC 平坦指数在性别间（P=.134）和创伤机制间（P=.701）无显著差异；然而，在低血压（收缩压[SBP]≤90mmHg 和/或舒张压[DBP]≤60mmHg；P=.015 和 P=.019）、心动过速（P=.049）和低氧血症（SpO2≤%94；P<.001）患者中，IVC 平坦指数较高。IVC 平坦指数在血乳酸≥2mmol/l（P=.043）和 III 级出血患者（P=.003）中也较高。血乳酸水平与 IVC 平坦指数呈正相关，格拉斯哥昏迷量表（GCS）和修订创伤评分（RTS）与 IVC 平坦指数呈负相关（均 P<.05）。
IVC 平坦指数可能是一种有用的方法，可用于早期确定多发创伤患者的低血容量性休克。
