Salman Sumbla, Laeeque Osama, Jawaid Bushra, Khalid Omer B, Shahab Hassan, Faheem Komal
General Surgery, Dow University of Health Sciences, Civil Hospital Karachi, Karachi, PAK.
Orthopaedics and Traumatology, Liaquat National Hospital, Karachi, PAK.
Cureus. 2023 Jul 3;15(7):e41305. doi: 10.7759/cureus.41305. eCollection 2023 Jul.
Patients with life-threatening hemorrhages due to blunt torso trauma are at a particularly high risk of being underdiagnosed. The pulse pressure (PP) starts narrowing down before the traditional parameters start changing, making it a useful tool for assessing and planning early intervention.
To assess the utility of low PP in predicting massive transfusion (MT) or operative intervention in patients with isolated blunt abdominal trauma.
A total of 186 patients were included. The PP and mean arterial pressure (MAP) were calculated. Vitals, PP, and MAP were monitored every 15 min during the first 6 h, then every 30 min during the next 6 h, and afterward, every 4 h until discharge. A Chi-square test and an independent t-test (as appropriate) were applied to compare variables with PP at the time of presentation. Differences were considered statistically significant at p-value ≤ 0.05.
A total of 55.9% of these patients had injuries due to road traffic accidents (RTA). Emergency operative intervention was provided to 26.3% of the patients. Death was 4.3%. MT was required by 26.3% of the patients. There was a statistically significant association between low PP and sex, length of stay, repeat extended focused assessment with sonography in trauma (eFAST), emergency operational intervention, outcome, MT, number of crystalloids consumed within the first four hours after presentation, injury severity score, systolic blood pressure (SBP), and pulse rate.
The PP <30 mmHg was observed as a useful predictor for increased blood loss requiring blood transfusion or operative intervention.
因钝性躯干创伤导致危及生命出血的患者存在特别高的漏诊风险。在传统参数开始变化之前，脉压（PP）就开始变窄，这使其成为评估和规划早期干预的有用工具。
评估低PP在预测单纯钝性腹部创伤患者大量输血（MT）或手术干预方面的效用。
共纳入186例患者。计算PP和平均动脉压（MAP）。在最初6小时内每15分钟监测一次生命体征、PP和MAP，接下来6小时内每30分钟监测一次，之后每4小时监测一次直至出院。应用卡方检验和独立t检验（酌情）比较就诊时各变量与PP的差异。p值≤0.05时差异被认为具有统计学意义。
这些患者中共有55.9%因道路交通事故（RTA）受伤。26.3%的患者接受了急诊手术干预。死亡率为4.3%。26.3%的患者需要MT。低PP与性别、住院时间、重复创伤超声重点评估（eFAST）、急诊手术干预、结局、MT、就诊后前四小时内晶体液用量、损伤严重程度评分、收缩压（SBP）和脉搏率之间存在统计学显著关联。
观察到PP<30 mmHg是需要输血或手术干预的失血增加的有用预测指标。
