Predicting haemorrhage in pre-hospital traumatic patients: evaluation of the novel heart-to-arm time index

Background Early recognition of hypovolaemia in trauma patients is very important. However, the most often used clinical signs, such as hypotension and tachycardia, lack specificity and sensitivity. Methods We propose a non‐invasive index of hypovolaemia, the heart to arm time (iHAT), based on a mod...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2013-08, Vol.57 (7), p.929-935
Main Authors: VETTORELLO, M., SANTAMBROGIO, S. M., CALINI, A. R., TIZZONI, L., MARCONI, G., LIPPI, M. G., SESANA, G., CHIARA, O., FUMAGALLI, R.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Algorithms
Area Under Curve
Arm - blood supply
Diagnostic Techniques, Cardiovascular
Drug therapy
Emergency Medical Services - methods
Female
Heart
Heart Rate
Hemorrhage - diagnosis
Hemorrhage - etiology
Hemorrhage - therapy
Humans
Male
Middle Aged
Prospective Studies
Pulse
ROC Curve
Sensitivity and Specificity
Shock - diagnosis
Shock - etiology
Shock - prevention & control
Time Factors
Unnecessary Procedures
Wounds and Injuries - complications
Wounds and Injuries - physiopathology
Young Adult
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Summary:Background Early recognition of hypovolaemia in trauma patients is very important. However, the most often used clinical signs, such as hypotension and tachycardia, lack specificity and sensitivity. Methods We propose a non‐invasive index of hypovolaemia, the heart to arm time (iHAT), based on a modified pulse transit time indexed to heart rate. Pulse transit time is the sum of pre‐ejection period and vascular transit time. Following pre‐load reductions due to hypovolaemia, ventricular diastolic filling time increases causing an increase in pre‐ejection‐period, pulse transit time, and hence iHAT. One hundred and four consecutive patients with suspected major trauma were enrolled. The primary aim was to evaluate the use of the iHAT for detecting haemorrhage in major trauma. The secondary end point was to compare the specificity and sensitivity of iHAT compared to commonly used indexes. Results iHAT was calculated in 84 subjects, 11 of whom were haemorrhagic. iHAT discriminated haemorrhagic from non‐haemorrhagic group (46.8% vs. 66.9%, P 
ISSN:0001-5172
1399-6576
DOI:10.1111/aas.12135