OBJECTIVE: To identify predictors of death due to hemorrhage in patients sustaining penetrating trauma to the torso admitted in shock. METHOD: Data was prospectively collected from Dec 1996 until Dec 1998. Patients presenting penetrating wounds from clavicles to inguinal ligaments, admitted with a systolic blood pressure (SBP) < 90mmHg were included. Those who died due to massive hemorrhage compounded group H and the others, group O. Variables were compared between the groups. Statistical treatment involved a multivariate analysis with Spearman dispersion, considering p<0.05 as significant, and a logistic regression. Seventy-four patients met the inclusion criteria. There were 62 males (83%), and the mean age was 29 + 8 years. The mean RTS, ISS and TRISS were respectively 5.4 + 2.1, 18 + 8 and 80 + 30. Nineteen died due to massive hemorrhage. RESULTS: The main predictors of lethal hemorrhage were: persistent shock despite volume replacement, systolic bood pressure in the beginning of the operation < 110mmHg, arterial pH < 7.25 in the beginning of operation, necessity of more than 1200ml of packed red blood cells during the operation and presence of vascular injury with AIS > 2. CONCLUSION: The risk of death due to hemorrhage can be assessed objectively. Based in this information, the selection of the patients for damage control becomes more objective and reliable.
Penetrating trauma; Shock; Hemorrhagic shock; Mortality; Prognosis