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Original Article

Unstable Without a Source: The Non-Diagnostic Triad in Hypotensive Blunt Trauma Victims

  • Robert Emmett Reily Tulane University
  • Tyler Simpson Tulane University School of Medicine
  • Morgan Evans
  • Alison A. Smith Tulane University School of Medicine
  • Juan Carolos Duchesne

Abstract

Background: Current algorithms for resuscitation in blunt trauma patients rely on chest x-ray, FAST, and pelvic x-ray to quickly elicit a source of major bleeding in the trauma bay.  There are currently no good recommendations for the patient in whom all three of these imaging studies are negative. 


Methods:  We identified blunt trauma victims who presented with a systolic blood pressure below 100mmHg.  Chest x-ray, FAST, and pelvic x-ray obtained in the trauma bay were reviewed, and patients who had all three studies negative underwent thorough chart review and characterization of injuries.  


Results:  Of the total hypotensive blunt trauma victims (n=649), we found 47 who had a “non-diagnostic triad” (NDT).  Of the NDT group, 31.9% (n=15) were found to have a major injury contributing to hypotension, while 61% (n=29) were not diagnosed with a severe injury that could have contributed to hypotension.  Of the NDT group with severe injury, 40% (n=6) were found to have retroperitoneal bleeding, 40% (n=6) were found to have intraperitoneal bleeding despite negative fast, 13% (n=2) were thought to have spinal shock, and one patient had a blunt cardiac injury.   


Conclusions:  Most of the NDT group patients in this study were not diagnosed with a serious injury.  However, a significant minority (31%) were found to have a major injury contributing to hypotension.  Of these patients, retroperitoneal and/or intra-abdominal bleeding were found in 80%, with neurogenic and cardiogenic shock less common.  We feel these sicker NDT patients may benefit from REBOA, although more study is warranted before formal algorithms and recommendations are made. 

Published

2019-01-30

How to Cite

REILY, Robert Emmett et al. Unstable Without a Source: The Non-Diagnostic Triad in Hypotensive Blunt Trauma Victims. Journal of Endovascular Resuscitation and Trauma Management, [S.l.], v. 3, n. 1, jan. 2019. ISSN 2002-7567. Available at: <http://journal.jevtm.com/index.php/jevtm/article/view/83>. Date accessed: 25 aug. 2019. doi: https://doi.org/10.26676/jevtm.v3i1.83.

Section

Original Article