J. Parks1, G. Vasileiou1, J. Parreco1, R. Rattan1, T. Zakrison1, D. G. Pust1, N. Namias1, D. D. Yeh1 1University Of Miami,Department Of Surgery,Miami, FL, USA
Introduction:
The Advanced Trauma Life Support (ATLS) Program of the American College of Surgeons shock classification has been accepted as the de facto conceptual framework for most clinicians caring for trauma patients. We sought to validate its usefulness and ability to predict mortality, blood transfusion, and urgent intervention.
Methods:
We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Adults (age ≥18) were included in the analysis if they were not missing data for vital signs, GCS, sex, or disposition. Using emergency department vital signs data, patients were categorized into shock class based on the 10th edition of ATLS, rates for blood product transfusion within 24 h, urgent operative intervention (laparotomy, thoracotomy, or IR embolization within 24 h), and in-hospital mortality were calculated.
Results:
After exclusions, 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 (48%) patients did not meet the criteria for any ATLS shock class and were not categorized. Clinical outcomes are presented in the Table. Uncategorized patients had a higher mortality (7.1%) than the patients in shock classes 1 and 2 combined. Additionally, Shock Classes 3 and 4 each only accounted for 0.009% and 0.013%, respectively, of the categorizable patients.
Conclusion:
Almost half of all trauma patients do not meet the criteria for any category of shock according to the ATLS classification definitions and Class 3 and 4 Shock accounted for <0.1% of all injured patients. The current classification system requires better calibration in order to include more patients and to be clinically useful in predicting meaningful outcomes.
