Abstract
IntroductionEmergency physicians (EP) frequently estimate blood loss, which can have implications for clinical care. The objectives of this study were to examine EP accuracy in estimating blood loss on different surfaces and compare attending physician and resident performance.MethodsA sample of 56 emergency department (ED) physicians (30 attending physicians and 26 residents) were asked to estimate the amount of moulage blood present in 4 scenarios: 500 mL spilled onto an ED cot; 25 mL spilled onto a 10-pack of 4 × 4-inch gauze; 100 mL on a T-shirt; and 150 mL in a commode filled with water. Standard estimate error (the absolute value of (estimated volume − actual volume)/actual volume × 100) was calculated for each estimate.ResultsThe mean standard error for all estimates was 116% with a range of 0% to 1233%. Only 8% of estimates were within 20% of the true value. Estimates were most accurate for the sheet scenario and worst for the commode scenario. Residents and attending physicians did not perform significantly differently (P > 0.05).ConclusionEmergency department physicians do not estimate blood loss well in a variety of scenarios. Such estimates could potentially be misleading if used in clinical decision making. Clinical experience does not appear to improve estimation ability in this limited study.
Highlights
Emergency physicians (EP) frequently estimate blood loss, which can have implications for clinical care
A sample of 56 emergency department (ED) physicians (30 attending physicians and 26 residents) were asked to estimate the amount of moulage blood present in 4 scenarios: 500 mL spilled onto an ED cot; 25 mL spilled onto a 10-pack of 4 3 4-inch gauze; 100 mL on a T-shirt; and 150 mL in a commode filled with water
Emergency department physicians do not estimate blood loss well in a variety of scenarios. Such estimates could potentially be misleading if used in clinical decision making
Summary
Emergency physicians (EP) frequently estimate blood loss, which can have implications for clinical care. Initial bedside hematocrit can often be a poor indicator of acute blood loss: children have a high physiologic reserve, and many cardiac medications, such as bblockers and calcium channel blockers, affect the normal response to blood loss. These examples are just a few in which estimation of blood loss can alter the assessment of volume status. Obstetricians, general surgeons, trauma surgeons, nurses, and paramedics have all been found to be neither precise nor accurate.[1,2,3,4,5,6] In a recent study, emergency physicians (EP) and paramedics were given vital signs and mechanism of injury asked to visually estimate blood loss in trauma scenarios. Estimations were again found to be both inaccurate and affected by the patient’s presentation.[7]
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