A systematic review of the relationship between blood loss and clinical signs.

<h4>Introduction</h4>This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage.<h4>Methods</h4>A systematic review of the literature was carried out...

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Autores principales:	Rodolfo Carvalho Pacagnella, João Paulo Souza, Jill Durocher, Pablo Perel, Jennifer Blum, Beverly Winikoff, Ahmet Metin Gülmezoglu
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/99a6cb8b6ac1491690f7065bfef2b4cb
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spelling	oai:doaj.org-article:99a6cb8b6ac1491690f7065bfef2b4cb2021-11-18T07:54:41ZA systematic review of the relationship between blood loss and clinical signs.1932-620310.1371/journal.pone.0057594https://doaj.org/article/99a6cb8b6ac1491690f7065bfef2b4cb2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23483915/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage.<h4>Methods</h4>A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE.<h4>Results</h4>30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality.<h4>Conclusion</h4>We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.Rodolfo Carvalho PacagnellaJoão Paulo SouzaJill DurocherPablo PerelJennifer BlumBeverly WinikoffAhmet Metin GülmezogluPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 3, p e57594 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Rodolfo Carvalho Pacagnella João Paulo Souza Jill Durocher Pablo Perel Jennifer Blum Beverly Winikoff Ahmet Metin Gülmezoglu A systematic review of the relationship between blood loss and clinical signs.
description	<h4>Introduction</h4>This systematic review examines the relationship between blood loss and clinical signs and explores its use to trigger clinical interventions in the management of obstetric haemorrhage.<h4>Methods</h4>A systematic review of the literature was carried out using a comprehensive search strategy to identify studies presenting data on the relationship of clinical signs & symptoms and blood loss. Methodological quality was assessed using the STROBE checklist and the general guidelines of MOOSE.<h4>Results</h4>30 studies were included and five were performed in women with pregnancy-related haemorrhage (other studies were carried in non-obstetric populations). Heart rate (HR), systolic blood pressure (SBP) and shock index were the parameters most frequently studied. An association between blood loss and HR changes was observed in 22 out of 24 studies, and between blood loss and SBP was observed in 17 out of 23 studies. An association was found in all papers reporting on the relationship of shock index and blood loss. Seven studies have used Receiver Operating Characteristic Curves to determine the accuracy of clinical signs in predicting blood loss. In those studies the AUC ranged from 0.56 to 0.74 for HR, from 0.56 to 0.79 for SBP and from 0.77 to 0.84 for shock index. In some studies, HR, SBP and shock index were associated with increased mortality.<h4>Conclusion</h4>We found a substantial variability in the relationship between blood loss and clinical signs, making it difficult to establish specific cut-off points for clinical signs that could be used as triggers for clinical interventions. However, the shock index can be an accurate indicator of compensatory changes in the cardiovascular system due to blood loss. Considering that most of the evidence included in this systematic review is derived from studies in non-obstetric populations, further research on the use of the shock index in obstetric populations is needed.
format	article
author	Rodolfo Carvalho Pacagnella João Paulo Souza Jill Durocher Pablo Perel Jennifer Blum Beverly Winikoff Ahmet Metin Gülmezoglu
author_facet	Rodolfo Carvalho Pacagnella João Paulo Souza Jill Durocher Pablo Perel Jennifer Blum Beverly Winikoff Ahmet Metin Gülmezoglu
author_sort	Rodolfo Carvalho Pacagnella
title	A systematic review of the relationship between blood loss and clinical signs.
title_short	A systematic review of the relationship between blood loss and clinical signs.
title_full	A systematic review of the relationship between blood loss and clinical signs.
title_fullStr	A systematic review of the relationship between blood loss and clinical signs.
title_full_unstemmed	A systematic review of the relationship between blood loss and clinical signs.
title_sort	systematic review of the relationship between blood loss and clinical signs.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/99a6cb8b6ac1491690f7065bfef2b4cb
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A systematic review of the relationship between blood loss and clinical signs.

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