Utility of base deficit for identifying major injury in elder trauma patients.

BACKGROUND: Early identification of serious injuries is especially important in elders. Base deficit (BD) is an indicator of serious injury in trauma patients. There are limited data to support the utility of BD in elders who have sustained trauma.

OBJECTIVES: To assess the diagnostic performance of BD in identifying major injury in elders.

METHODS: This was a prospective, observational, preliminary study. Elder (age 65 years and older) patients with significant injury mechanisms had BD analyzed during initial emergency department resuscitation. Major injury was defined by an Injury Severity Score > or =15, a decrease in hematocrit of more than ten points, or blood transfusion. Patients were stratified into two groups of minor and major injuries. Data were reported as means (+/-SD). Receiver operating characteristic (ROC) curves tested the diagnostic ability of BD to identify major injury.

RESULTS: Seventy-four patients were enrolled; the mean (+/-SD) age was 75 (+/-7) years, and 57% were male. Twenty-four patients (32%) had major injury. The mean (+/-SD) for BD in the major injury group (-2.9 [+/-6] mmol/L) was significantly different from that in the minor injury group (0.8 [+/-3] mmol/L), with a mean difference of 3.7 (95% confidence interval = 1.4 to 5.9). ROC curves revealed that BD was able to identify major injury in elder patients (area under the ROC curve, 0.72; 95% confidence interval = 0.60 to 0.85; p = 0.0003).

CONCLUSIONS: The preliminary data from this study indicate that in trauma patients aged 65 years and older, increased BD at emergency department arrival can predict life-threatening injury.