Predictors of patients who will develop prolonged occult hypoperfusion following blunt trauma

Background: Prolonged occult hypoperfusion or POH (serum lactate >2.4 mmol/L persisting > 12 hours from admission) represents a reversible risk factor for adverse outcomes following traumatic injury. We hypothesized that patients at increased risk for POH could be identified at the time of admission. Methods: Prospective data from adult trauma admissions between January 1, 1998 and December 31, 2000 were analyzed. Potential risk factors for POH were determined by univariate analysis (p less than or equal to 0.10 = significant). Significant factors were tested in a logistic regression model (LR) (p less than or equal to 0.05 = significant). The predictive ability of the LR was tested by receiver operating curve (ROC) analysis (p less than or equal to 0.05 = significant). Results: Three hundred seventy-eight patients were analyzed, 129 with POH. Injury Severity Score (ISS), emergency department Glasgow Coma Scale score, hypotension, and the individual Abbreviated Injury Scale score (AIS) for Head (H), Abdominal/Pelvic Viscera (A) and Pelvis/Bony Extremity (P) were significantly associated with POH. LR demonstrated that ISS, A-AIS greater than or equal to3 and P-AIS greater than or equal to3 were independent predictors of POH (p < 0.05). ROC analysis of the LR equation was statistically significant (Area 0.69, p < 0.001). Conclusions: We identified factors at admission that placed patients at higher risk for developing POH. Select patients may benefit from rapid, aggressive monitoring and resuscitation, possibly preventing POH and its associated morbidity and mortality.