- Keywords
- kolaps vitálních funkcí,
- MeSH
- Cardiopulmonary Resuscitation classification methods MeSH
- Case Reports as Topic MeSH
- Humans MeSH
- Sudden Infant Death etiology MeSH
- Infant, Newborn MeSH
- Risk Factors MeSH
- Shock * diagnosis classification MeSH
- Vital Signs * MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
- MeSH
- Bronchopulmonary Dysplasia diagnosis complications MeSH
- Drug Therapy classification MeSH
- Cardiovascular Diseases diagnosis classification physiopathology MeSH
- Case Reports as Topic MeSH
- Humans MeSH
- Infant, Extremely Premature MeSH
- Infant, Newborn MeSH
- Fetal Growth Retardation diagnosis MeSH
- Shock * diagnosis etiology drug therapy classification MeSH
- Terlipressin * pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
BACKGROUND: The Advanced Trauma Life Support classification (ATLS) of hypovolemic shock is a widely used teaching and treatment reference in emergency medicine, but oversimplifies clinical reality. A decade ago, a landmark study compared vital parameters to base deficit (BD) in trauma patients. The investigators concluded that BD had higher accuracy to detect the need for early blood product administration. BD was subsequently introduced in the ATLS shock classification and has since been widely accepted as a laboratory standard for hypovolemia. The aim of this study is to investigate whether a methodological bias may have inadvertently contributed to the study's results and interpretation. METHODS: In the current study, we replicate the original study by simulating a cohort of trauma patients with randomly generated data and applying the same methodological strategies. First, a predefined correlation between all predictor variables (vital parameters and BD) and outcome variable (transfusion) was set at 0.55. Then, in accordance with the methods of the original study we created a composite of ATLS parameters (highest class amongst heart rate, systolic blood pressure, and Glasgow Coma Scale) and compared it with BD for resulting transfusion quantity. Given the preset correlations between predictors and outcome, no predictor should exhibit a stronger association unless influenced by methodological bias. RESULTS: Applying the original imbalanced grouping and composite allocation strategies caused a systematic overestimation of shock class for traditional ATLS parameters, favoring the association between BD and transfusion. This effect persisted when the correlation between BD and transfusion was set substantially worse (rho = 0.3) than the correlation between ATLS parameters and transfusion (rho = 0.8). CONCLUSIONS: In this fully reproducible simulation, we confirm the inadvertent presence of methodological bias. It is physiologically reasonable to include a metabolic parameter to classify hypovolemic shock, but more evidence is needed to support widespread and preferred use of BD.
- MeSH
- Shock, Hemorrhagic diagnosis etiology MeSH
- Hypotension diagnosis etiology classification MeSH
- Shock, Cardiogenic diagnosis etiology MeSH
- Catecholamines pharmacology therapeutic use MeSH
- Multiple Organ Failure diagnosis etiology MeSH
- Shock * diagnosis drug therapy classification physiopathology MeSH
- Publication type
- Review MeSH
- MeSH
- Hemodynamics MeSH
- Humans MeSH
- Shock * classification physiopathology therapy MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Acute Pain diagnosis complications therapy MeSH
- Cardiopulmonary Resuscitation methods MeSH
- Humans MeSH
- Aftercare methods MeSH
- Palliative Care MeSH
- Post-Cardiac Arrest Syndrome prevention & control MeSH
- Respiratory Insufficiency etiology physiopathology therapy MeSH
- Advanced Cardiac Life Support methods MeSH
- Shock diagnosis classification physiopathology therapy MeSH
- Heart Arrest etiology drug therapy MeSH
- Emergency Treatment * methods MeSH
- Respiration, Artificial classification methods MeSH
- Accidents classification MeSH
- Emergency Medicine * methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Epinephrine administration & dosage MeSH
- Anaphylaxis * diagnosis etiology drug therapy pathology prevention & control MeSH
- Anti-Allergic Agents administration & dosage classification therapeutic use MeSH
- Child MeSH
- Adrenal Cortex Hormones administration & dosage therapeutic use MeSH
- Humans MeSH
- Shock classification MeSH
- Age Factors MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Anaphylaxis diagnosis physiopathology therapy MeSH
- Diagnosis, Differential MeSH
- Embolism, Amniotic Fluid diagnosis physiopathology therapy MeSH
- Shock, Hemorrhagic etiology physiopathology therapy MeSH
- Shock, Cardiogenic etiology physiopathology therapy MeSH
- Obstetric Labor Complications MeSH
- Pregnancy Complications etiology physiopathology MeSH
- Humans MeSH
- Pulmonary Embolism diagnosis physiopathology therapy MeSH
- Shock * etiology classification physiopathology MeSH
- Systemic Inflammatory Response Syndrome diagnosis complications therapy MeSH
- Pregnancy MeSH
- Check Tag
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Review MeSH
- Keywords
- systémová dodávka kyslíku, předtížení, preload, plicnicová termidiluce, tlaková křivka, Frankova-Starlingova křivka,
- MeSH
- Algorithms MeSH
- Colon, Sigmoid pathology MeSH
- Diverticulitis, Colonic surgery diagnostic imaging MeSH
- Echocardiography MeSH
- Hemodynamic Monitoring classification MeSH
- Hemodynamics * physiology drug effects MeSH
- Hypotension drug therapy MeSH
- Colloids classification therapeutic use MeSH
- Blood Pressure physiology drug effects MeSH
- Crystalloid Solutions classification therapeutic use MeSH
- Oxygen physiology MeSH
- Pharmaceutical Preparations classification MeSH
- Middle Aged MeSH
- Humans MeSH
- Monitoring, Physiologic classification MeSH
- Pneumoperitoneum surgery diagnostic imaging MeSH
- Tomography, X-Ray Computed MeSH
- Prognosis MeSH
- Shock * diagnosis drug therapy classification physiopathology therapy MeSH
- Systemic Inflammatory Response Syndrome diagnosis MeSH
- Fluid Therapy MeSH
- Vasoconstrictor Agents classification therapeutic use MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Publication type
- Case Reports MeSH
- Review MeSH
- Keywords
- Downes skóre,
- MeSH
- Hypersensitivity therapy MeSH
- Anaphylaxis etiology drug therapy prevention & control therapy MeSH
- Respiratory Aspiration therapy MeSH
- Unconsciousness diagnosis etiology therapy MeSH
- Bronchiolitis pathology therapy MeSH
- Dehydration diagnosis therapy MeSH
- Diagnosis, Differential MeSH
- Child MeSH
- Edema therapy MeSH
- Epiglottitis diagnosis pathology therapy MeSH
- Glasgow Coma Scale MeSH
- Communicable Diseases diagnosis epidemiology therapy MeSH
- Cardiopulmonary Resuscitation methods MeSH
- Spasms, Infantile diagnosis etiology therapy MeSH
- Laryngitis diagnosis pathology MeSH
- Pharmaceutical Preparations MeSH
- Humans MeSH
- Adolescent MeSH
- Emergencies * classification MeSH
- Infant, Newborn MeSH
- Airway Obstruction classification MeSH
- Poisoning therapy MeSH
- Shock diagnosis classification therapy MeSH
- Severity of Illness Index MeSH
- Age Factors MeSH
- Equipment and Supplies MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
