The role of heart rate in the initial assessment of bleeding in trauma patients - A Systematic Review and Meta-regression
Creators: name: Jávor, Péter
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Medicine and Health Sciences
subject: Medical Specialties
subject: Critical Care
subject: Trauma

description: Our Systematic Review investigates the role of heart rate (HR) in the initial assessment of trauma patients with hemorrhage. Regarding the efficiency of HR as a predictor of outcome in trauma, there are contradictory data in literature. Furthermore, Advanced Trauma Life Support (ATLS) suggests a continuous increase in the HR value in accordance with the severity of bleeding; However, the HR response to hemorrhage is rather biphasic or triphasic than linear. Since there were several changes and a paradigm shift regarding the initial fluid resuscitation approach in trauma care in the past decades, we aimed to update current knowledge about the role of HR in severe trauma, and to test the validity of the current suggestions of ATLS regarding the alterations of HR in hemorrhage. A systematic search of EMBASE, MEDLINE, Cochrane and World of Science databases was performed with the following search terms: "trauma" AND "heart rate" OR "pulse rate" OR "tachycardia" OR "bradycardia" OR "vital sign" OR "vital signs" OR "vital parameter" OR "vital parameters" AND "mortality" AND "bleeding" OR "haemorrhage" OR "hemorrhage" OR "haemodynamic" OR "hemodynamic". Records on bleeding trauma patients were considered for eligibility only if they provided initial HR values (prehospital (PH) or on admission (AD)) and a mortality data covering a time interval not exceeding 30 days from the time of injury. If the inclusion criteria of the individual studies included transfusion of blood products and/or positive FAST examination and/or hemodinamical instability after trauma and/or abdominal gunshot injury, the patient cohort was considered as hemorrhagic. Non-English language reports, records on pediatric, geriatric and pregnant populations were not considered. Studies on patients suffered burns, traumatic spinal or- brain injuries were excluded. Because of the paradigm shifts and several minor modifications in the management of hemodinamically instabil trauma patients in the past decades, all studies that processed data from earlier than 2010 were also excluded. The eligibility of records was assessed separately by two authors. Disagreements were resolved by consensus with the help of a third party. After having duplicates removed with the help of a reference manager software (EndNote X7), articles published before 2010 were also discarded. On the remaining studies, title and abstract screenings were performed by the two review authors. Thereafter, the full texts of the potentially eligible records were obtained and assessed based on the criteria described above. The following information was extracted from the eligible studies: title, first author, year of publication (2010-), study design, data origin (hospital database/registry), data collection period (2010-), inclusion criteria, subgroups, patient number of the subgroups, total patient number, HR (mean ± SD or median [IQR]), phase of recording HR values (PH/AD), mortality (n, %), follow up (24-hour/3 day/30-day/in hospital). If there were multiple publications from the same register with overlapping data collection periods, the less comprehensive report was excluded. To convert median values to means, we used the method of Xiang Wan. We used the Cochrane risk-of-bias tool to assess the risk of bias for each study. Demographic, quality, and outcome data were extracted independently into Microsoft Excel by two authors. Data were taken from all articles describing the studies. Any questions in data extraction were settled by discussion with a third author. The association between HR and mortality of trauma patients was assessed using meta-regression analysis. A result of p&lt;0.05 was considered as significant. As a subgroup analysis, meta-regression was also performed for trauma patients receiving blood products. Statistical analyses were performed with Stata 16 (Stata Corp, College Station, TX, USA).