Emergency department spirometric volume and base deficit delineate risk for torso injury in stable patients

Abstract

Background: We sought to determine torso injury rates and sensitivities associated with fluid-positive abdominal ultrasound, metabolic acidosis (increased base deficit and lactate), and impaired pulmonary physiology (decreased spirometric volume and PaO2/FiO2). Methods: Level I trauma center prospective pilot and post-pilot study (2000-2001) of stable patients. Increased base deficit was < 0.0 in ethanol-negative and ≤ -3.0 in ethanol-positive patients. Increased lactate was > 2.5 mmol/L in ethanol-negative and ≥ 3.0 mmol/L in ethanol-positive patients. Decreased PaO2(FiO2 was < 350 and decreased spirometric volume was < 1.8 L. Results: Of 215 patients, 66 (30.7%) had a torso injury (abdominal/pelvic injury n = 35 and/or thoracic injury n = 43). Glasgow Coma Scale score was 14.8 ± 0.5 (13-15). Torso injury rates and sensitivities were: abdominal ultrasound negative and normal base deficit, lactate, PaO 2FiO2, and spirometric volume - 0.0% & 0.0%; normal base deficit and normal spirometric volume - 4.2% & 4.5%; chest/abdominal soft tissue injury - 37.8% & 47.0%; increased lactate - 39.7% & 47.0%; increased base deficit - 41.3% & 75.8%; increased base deficit and/or decreased spirometric volume - 43.8% & 95.5%; decreased PaO 2FiO2 - 48.9% & 33.3%; positive abdominal ultrasound - 62.5% & 7.6%; decreased spirometric volume - 73.4% & 71.2%; increased base deficit and decreased spirometric volume - 82.9% & 51.5%. Conclusions: Trauma patients with normal base deficit and spirometric volume are unlikely to have a torso injury. Patients with increased base deficit or lactate, decreased spirometric volume, decreased PaO2FiO2, or positive FAST have substantial risk for torso injury. Increased base deficit and/or decreased spirometric volume are highly sensitive for torso injury. Base deficit and spirometric volume values are readily available and increase or decrease the suspicion for torso injury.