Abstract
BackgroundEarly prognostication in trauma patients is challenging, but particularly important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. We also evaluated copeptin performance in predicting other clinical outcomes: mortality, hospital admission, blood transfusion, emergency surgery, and Intensive Care Unit (ICU) admission.MethodsThis single center, pragmatic, prospective observational study was conducted at Arcispedale Santa Maria Nuova, a level II trauma center in Reggio Emilia, Italy. Copeptin determination was obtained on Emergency Department (ED) arrival, together with venous lactate. Different outcomes were measured including ISS, Revised Trauma Score (RTS), hospital and ICU admission, blood transfusion, emergency surgery, and mortality.ResultsOne hundred and twenty five adult trauma patients admitted to the ED between June 2017 and March 2018. Copeptin showed a good ability to identify patients with ISS > 15 (AUC 0.819). Similar good performances were recorded also in predicting other outcomes. Copeptin was significantly superior to lactate in identifying patients with ISS > 15 (P 0.0015), and in predicting hospital admission (P 0.0002) and blood transfusion (P 0.016). Comparable results were observed in a subgroup of patients with RTS 7.84.ConclusionsIn a heterogeneous group of trauma patients, a single copeptin determination at the time of ED admission proved to be an accurate biomarker, statistically superior to lactate for the identification of major trauma, hospital admission, and blood transfusion, while no statistical difference was observed for ICU admission and emergency surgery. These results, if confirmed, may support a role for copeptin during early management of trauma patients.
Highlights
Prognostication in trauma patients is challenging, but important
The final decision whether to enroll a patient was left to the treating emergency physician and trauma team leader: if the patient was perceived as a “potential major trauma”, a “trauma code” was activated and the patient was included in the study
No statistical difference was observed in emergency surgery (AUC 0.843 vs 0.679, P 0.087) and Intensive Care Unit (ICU) admission (AUC 0.846 vs 0.741, P 0.088), despite a Discussion In our heterogeneous group of trauma patients, a single copeptin determination at the time of Emergency Department (ED) admission proved to be an accurate biomarker for the identification of major trauma and a reliable predictor of subsequent hospital admission, emergency surgery, blood transfusion, and ICU admission
Summary
Prognostication in trauma patients is challenging, but important. We wanted to explore the ability of copeptin, the C-terminal fragment of arginine vasopressin, to identify major trauma, defined as Injury Severity Score (ISS) > 15, in a heterogeneous cohort of trauma patients and to compare its performances with lactate. Especially those with altered vital signs, do not pose a particular prognostic challenge during early triage and are usually correctly referred to the appropriate facility [2]. This process is not so obvious for trauma patients who initially appear in good and stable conditions, but whose conditions deteriorate. Salvo et al BMC Emergency Medicine (2020) 20:14 rapidly later on In this grey area management errors are common: overtriage may be considered an option to avoid misplacement of major trauma patients, but it can lead to negative consequences, such as burdening trauma centers with inappropriate patients, separating patients from their families and communities, or increasing the number of unnecessary transportations [3]. There are other complex prognostic scores, such as the Injury Severity Score (ISS), which can be calculated only after the completion of all the diagnostic procedures, having no role in the triage process [8]
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