Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the pat...

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Autores principales:	Fang-Yu Hsu, Shih-Hsuan Mao, Andy Deng-Chi Chuang, Yon-Cheong Wong, Chih-Hao Chen
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	traumatic oronasal bleeding transarterial embolization craniofacial trauma shock index systolic blood pressure heart rate Medicine R
Acceso en línea:	https://doaj.org/article/47477005f4ae4ac38cc848720f134312
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spelling	oai:doaj.org-article:47477005f4ae4ac38cc848720f1343122021-11-11T16:12:12ZShock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding10.3390/ijerph1821110511660-46011661-7827https://doaj.org/article/47477005f4ae4ac38cc848720f1343122021-10-01T00:00:00Zhttps://www.mdpi.com/1660-4601/18/21/11051https://doaj.org/toc/1661-7827https://doaj.org/toc/1660-4601The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (<i>p</i> < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.Fang-Yu HsuShih-Hsuan MaoAndy Deng-Chi ChuangYon-Cheong WongChih-Hao ChenMDPI AGarticletraumatic oronasal bleedingtransarterial embolizationcraniofacial traumashock indexsystolic blood pressureheart rateMedicineRENInternational Journal of Environmental Research and Public Health, Vol 18, Iss 11051, p 11051 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	traumatic oronasal bleeding transarterial embolization craniofacial trauma shock index systolic blood pressure heart rate Medicine R
spellingShingle	traumatic oronasal bleeding transarterial embolization craniofacial trauma shock index systolic blood pressure heart rate Medicine R Fang-Yu Hsu Shih-Hsuan Mao Andy Deng-Chi Chuang Yon-Cheong Wong Chih-Hao Chen Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
description	The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (<i>p</i> < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.
format	article
author	Fang-Yu Hsu Shih-Hsuan Mao Andy Deng-Chi Chuang Yon-Cheong Wong Chih-Hao Chen
author_facet	Fang-Yu Hsu Shih-Hsuan Mao Andy Deng-Chi Chuang Yon-Cheong Wong Chih-Hao Chen
author_sort	Fang-Yu Hsu
title	Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
title_short	Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
title_full	Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
title_fullStr	Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
title_full_unstemmed	Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding
title_sort	shock index as a predictor for angiographic hemostasis in life-threatening traumatic oronasal bleeding
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/47477005f4ae4ac38cc848720f134312
work_keys_str_mv	AT fangyuhsu shockindexasapredictorforangiographichemostasisinlifethreateningtraumaticoronasalbleeding AT shihhsuanmao shockindexasapredictorforangiographichemostasisinlifethreateningtraumaticoronasalbleeding AT andydengchichuang shockindexasapredictorforangiographichemostasisinlifethreateningtraumaticoronasalbleeding AT yoncheongwong shockindexasapredictorforangiographichemostasisinlifethreateningtraumaticoronasalbleeding AT chihhaochen shockindexasapredictorforangiographichemostasisinlifethreateningtraumaticoronasalbleeding
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Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

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