Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-08T03:32:30.539Z Has data issue: false hasContentIssue false
  • English
  • Français

The Flatness Index of Inferior Vena Cava can be an Accurate Predictor for Hypovolemia in Multi-Trauma Patients

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  06 May 2021

Nazlı Ozcan Yazlamaz ,
Engin Ozakin Open the ORCID record for Engin Ozakin [Opens in a new window] ,
Betül T. Bastug ,
Evvah Karakilic ,
Filiz Baloglu Kaya ,
Nurdan Acar  and
Rusengul Koruk
Nazlı Ozcan Yazlamaz
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
Engin Ozakin*
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
Betül T. Bastug
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Radiology, Eskisehir, Turkey
Evvah Karakilic
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
Filiz Baloglu Kaya
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
Nurdan Acar
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
Rusengul Koruk
Affiliation:
Eskisehir Osmangazi University Medical Center, Department of Emergency Medicine, Eskisehir, Turkey
*
Correspondence: Engin Özakın Eskisehir Osmangazi University Medical Center Department of Emergency Medicine Meselik, 26480, Eskisehir, Turkey E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Shock is the leading cause of death in multi-trauma patients and must be detected at an early stage to improve prognosis. Many parameters are used to predict clinical condition and outcome in trauma. Computed tomography (CT) signs of hypovolemic shock in trauma patients are not clear yet, requiring further research. The flatness index of inferior vena cava (IVC) is a helpful method for this purpose.

Methods:

This is a prospective, cross-sectional study which included adult multi-trauma patients (>18 years) who were admitted to the emergency department (ED) and underwent a thoraco-abdominal CT from 2017 through 2018. The main objective of this study was to investigate whether the flatness index of IVC can be used to determine the hypovolemic shock at an early stage in multi-trauma patients, and to establish its relations with shock parameters. The patients’ demographic features, trauma mechanisms, vitals, laboratory values, shock parameters, and clinical outcome within 24 hours of admission were recorded.

Results:

Total of 327 (229 males with an average age of 40.9 [SD = 7.93]) patients were included in the study. There was no significant difference in the flatness index of IVC within genders (P = .134) and trauma mechanisms (P = .701); however, the flatness index of IVC was significantly higher in hypotensive (systolic blood pressure [SBP] ≤90 mmHg and/or diastolic blood pressure [DBP] ≤60 mmHg; P = .015 and P = .019), tachycardic (P = .049), and hypoxic (SpO2 ≤%94; P <.001) patients. The flatness index of IVC was also higher in patients with lactate ≥ 2mmol/l (P = .043) and patients with Class III hemorrhage (P = .003). A positive correlation was determined between lactate level and the flatness index of IVC; a negative correlation was found between Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) with the flatness index of IVC (for each of them, P <.05).

Conclusion:

The flatness index of IVC may be a useful method to determine the hypovolemic shock at an early stage in multi-trauma patients.

Keywords

computed tomographyflatness index of inferior vena cavahypovolemic shockmulti-trauma
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 36 , Issue 4 , August 2021 , pp. 414 - 420
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Villaveces, A, Mutter, R, Owens, PL, Barrett, ML. Causes of Injuries Treated in the Emergency Department, 2010: Statistical Brief #156. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, Maryland USA: Agency for Healthcare Research and Quality (US); 2013.Google Scholar
Hardaway, RM. Traumatic and septic shock alias post-trauma critical illness. Br J Surg. 1998;85(11):1473–1479.CrossRefGoogle ScholarPubMed
Mbanjumucyo, G, George, N, Kearney, A, et al. Epidemiology of injuries and outcomes among trauma patients receiving prehospital care at a tertiary teaching hospital in Kigali, Rwanda. Afr J Emerg Med. 2016;6(4):191–197.CrossRefGoogle Scholar
Stewart, RM, Myers, JG, Dent, DL, et al. Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention. J Trauma. 2003;54(1):66–70.CrossRefGoogle Scholar
Ozakin, E, Yazlamaz, NO, Kaya, FB, Karakilic, EM, Bilgin, M. Perfusion index measurement in predicting hypovolemic shock in trauma patients. J Emerg Med. 2020;59(2):238–245.CrossRefGoogle ScholarPubMed
de Valk, S, Olgers, TJ, Holman, M, Ismael, F, Ligtenberg, JJM, ter Maaten, JC. The caval index: an adequate non-invasive ultrasound parameter to predict fluid responsiveness in the emergency department? BMC Anesthesiol. 2014;14:114.CrossRefGoogle ScholarPubMed
Monge García, MI, Gil Cano, A, Díaz Monrové, JC. Brachial artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients. Crit Care. 2009;13(5):R142.CrossRefGoogle ScholarPubMed
Lyon, M, Blaivas, M, Brannam, L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45–50.CrossRefGoogle ScholarPubMed
Yanagawa, Y, Sakamoto, T, Okada, Y. Hypovolemic shock evaluated by sonographic measurement of the inferior vena cava during resuscitation in trauma patients. J Trauma. 2007;63(6):1245–1248.Google ScholarPubMed
Michard, F, Alaya, S, Zarka, V, Bahloul, M, Richard, C, Teboul, JL. Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest. 2003;124(5):1900–1908.CrossRefGoogle ScholarPubMed
Jeffrey, RB, Federle, MP. The collapsed inferior vena cava: CT evidence of hypovolemia. AJR Am J Roentgenol. 1988;150(2):431–432.CrossRefGoogle ScholarPubMed
Johnson, JJ, Garwe, T, Albrecht, RM, et al. Initial inferior vena cava diameter on computed tomographic scan independently predicts mortality in severely injured trauma patients. J Trauma Acute Care Surg. 2013;74(3):741–745.CrossRefGoogle ScholarPubMed
Nguyen, A, Plurad, DS, Bricker, S, et al. Flat or fat? Inferior vena cava ratio is a marker for occult shock in trauma patients. J Surg Res. 2014;192(2):263–267.CrossRefGoogle ScholarPubMed
Butcher, N, Balogh, ZJ. The definition of polytrauma: the need for international consensus. Injury. 2009;40(Suppl 4):S12–22.CrossRefGoogle ScholarPubMed
Allgöwer, M, Burri, C. Shock-index. Ger Med Mon. 1968;13(1):14–19.Google ScholarPubMed
Manoochehry, S, Vafabin, M, Bitaraf, S, Amiri, A. A comparison between the ability of Revised Trauma Score and Kampala Trauma Score in predicting mortality: a meta-analysis. Arch Acad Emerg Med. 2019;7(1):e6.Google ScholarPubMed
Champion, HR, Sacco, WJ, Copes, WS, Gann, DS, Gennarelli, TA, Flanagan, ME. A revision of the Trauma Score. J Trauma. 1989;29(5):623–629.CrossRefGoogle ScholarPubMed
Barber, JL, Touska, P, Negus, AS. Inferior vena cava caliber on pediatric trauma CT may be a useful predictor for the development of shock. Clin Radiol. 2016;71(6):565–569.CrossRefGoogle Scholar
Li, Y, Zhang, LY, Wang, Y, Zhang, WG. The flatness index of inferior vena cava is useful in predicting hypovolemic shock in severe multiple-injury patients. J Emerg Med. 2013;45(6):872–878.CrossRefGoogle ScholarPubMed
Aldrian, S, Koenig, F, Weninger, P, Vécsei, V, Nau, T. Characteristics of polytrauma patients between 1992 and 2002: what is changing? Injury. 2007;38(9):1059–1064.CrossRefGoogle ScholarPubMed
Bashah, DT, Dachew, BA, Tiruneh, BT. Prevalence of injury and associated factors among patients visiting the emergency departments of Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study. BMC Emerg Med. 2015;15(1):20.10.1186/s12873-015-0044-3CrossRefGoogle ScholarPubMed
Jm, N, Ck van der S, J van der N, Mw N, Hj TD. Two cohorts of severely injured trauma patients, nearly two decades apart: unchanged mortality but improved quality of life despite higher age. J Trauma. 2007;63(3):670–675.Google Scholar
Abbasi, HR, Mousavi, SM, Taheri Akerdi, A, Niakan, MH, Bolandparvaz, S, Paydar, S. Pattern of traumatic injuries and injury severity score in a major trauma center in Shiraz, Southern Iran. Bull Emerg Trauma. 2013;1(2):81–85.Google Scholar
Blow, O, Magliore, L, Claridge, JA, Butler, K, Young, JS. The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma. 1999;47(5):964–969.CrossRefGoogle ScholarPubMed
Claridge, JA, Crabtree, TD, Pelletier, SJ, Butler, K, Sawyer, RG, Young, JS. Persistent occult hypoperfusion is associated with a significant increase in infection rate and mortality in major trauma patients. J Trauma. 2000;48(1):8–14.CrossRefGoogle ScholarPubMed
Citilcioglu, S, Sebe, A, Oguzhan Ay, M. The relationship between inferior vena cava diameter measured by bedside ultrasonography and central venous pressure value. Pak J Med Sci. 2014;30(2):310–315.CrossRefGoogle ScholarPubMed
Lorsomradee, S, Lorsomradee, S, Cromheecke, S, ten Broecke, PW, De Hert, SG. Inferior vena cava diameter and central venous pressure correlation during cardiac surgery. J Cardiothorac Vasc Anesth. 2007;21(4):492–496.CrossRefGoogle ScholarPubMed
Liao, Y-Y, Lin, H-J, Lu, Y-H, Foo, N-P, Guo, H-R, Chen, K-T. Does CT evidence of a flat inferior vena cava indicate hypovolemia in blunt trauma patients with solid organ injuries? J Trauma. 2011;70(6):1358–1361.Google ScholarPubMed