The use of routine laboratory testing in acute trauma care: A retrospective analysis

BACKGROUND: In more than 60 countries worldwide, laboratory testing plays a challenging and expensive role in trauma resus-citation. In 1995, the literature already suggested that routine laboratory testing may not be useful for most trauma patients. Our study hypothesized that still the need for some laboratory tests perhaps should be reconsidered. Therefore, the aim of this study was to create more insight in the distribution between normal and abnormal parameters for routine laboratory testing in trauma patient management.
METHODS: This retrospective analysis was performed at Amsterdam UMC, location AMC, an academic level 1 trauma center. Data concerning age, gender, American Society of Anesthesiologists (ASA) physical state classification system (ASA), Injury Severity Scores, Glasgow Coma Scales, mechanism of injury, presence of high-energy trauma, and type of injury (blunt or penetrating) were obtained. Laboratory parameters included comprehensive hematology, coagulation, arterial blood gas, kidney, and liver blood panels. Analytical focus was paid to the patient’s vital status, the indication for an emergency intervention, and the risk of in-hospital mortality.
RESULTS: A total of 1287 patients were included in the study. Patients with unstable vital signs or who required emergency inter-vention were most often dealing with abnormalities in pO2, glucose, D-dimer, creatinine, and alcohol values. Mean corpuscular volume (MCV), international normalized ratio (INR), fibrinogen, and amylase were obtained in more than 80% of the patients, but in specific patient groups only abnormal in less than 9%.
CONCLUSION: Trauma patients suffer mainly from abnormal values of D-dimer, pO2, glucose, creatinine, and alcohol. By contrast, MCV, INR, amylase, fibrinogen, and thrombocytes are regularly obtained as well, but only abnormal in a small amount of trauma patients. These findings suggest reconsiderations and more accuracy in the performance of laboratory testing, especially for trauma patients with stable vital signs.

Akut travmada rutin laboratuvar testlerinin kullanýmý: Geriye dönük bir analiz

AMAÇ: Dünya çapýnda 60’tan fazla ülkede, laboratuvar testlerinin travma resüsitasyonunda zorlu ve pahalý bir rolü vardýr. Literatürde 1995’te, rutin laboratuvar testlerinin çoðu travma hastasý için yararlý olmayabileceði zaten önerilmiþti. Çalýþmamýz, bazý laboratuvar testlerine olan ihtiyacýnýn yeniden gözden geçirilebileceðini varsaymaktadýr. Bu çalýþmanýn amacý, travma hastasý yönetiminde rutin laboratuvar testlerinde normal ve anormal parametreler arasýndaki daðýlým hakkýnda daha fazla bilgi oluþturmaktýr.
GEREÇ VE YÖNTEM: Bu geriye dönük analiz, Seviye 1 travma merkezi olan Amsterdam UMC (AMC)’de gerçekleþtirildi. Yaþ, cinsiyet, Fiziksel Du-rum Sýnýflandýrma Sistemi (ASA), Yaralanma Þiddet Skoru (ISS), Glasgow Koma Ölçeði (GCS), yaralanma mekanizmasý (MOI), yüksek enerjili travma varlýðý (HET) ve yaralanma türü (künt veya penetran) ile ilgili veriler elde edilmiþtir. Laboratuvar parametreleri kapsamlý hematoloji ve pýhtýlaþma testleri, arter kan gazý, böbrek ve karaciðer kan panellerini içermekteydi. Analitik olarak hastanýn hayati durumuna, acil müdahale endikasyonuna ve hastane içi ölüm riskine odaklanýldý.
BULGULAR: Araþtýrmaya toplam 1287 hasta alýndý. Stabil olmayan yaþamsal belirtileri olan veya acil müdahale gerektiren hastalarda çoðunlukla pO2, glukoz, D-dimer, kreatinin ve alkol deðerlerinde anormallikler mevcuttu. Hastalarýn %80’inden fazlasýnda MCV, INR, fibrinojen ve amilaz deðerleri elde edilmekle birlikte, sadece %9’dan azýnda ve spesifik hasta gruplarýnda anormal deðerler görüldü.
TARTIÞMA: Travma hastalarýnda esas olarak anormal D-dimer, pO2, glukoz, kreatinin ve alkol deðerleri görülmüþtür. Buna karþýlýk, MCV, INR, ami-laz, fibrinojen ve trombosit deðerleri sadece az sayýda travma hastasýnda anormal olarak gözlenmiþtir. Bu bulgular, özellikle stabil yaþamsal belirtileri olan travma hastalarý için laboratuvar testlerinin performansýnda yeniden deðerlendirme ve daha fazla doðrulama önermektedir.