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Serial hematocrit testing does not identify major injuries in trauma patients in an observation unit
Troy Madsen1, Matthew Dawson, Joseph Bledsoe
1Division of Emergency Medicine, University of Utah, Salt Lake City, UT 84132, USA. troy.madsen@hsc.utah.edu
Background:
Routine serial hematocrit measurements are a component of the trauma evaluation for patients without serious injury identified on initial evaluation. We sought to determine whether serial hematocrit testing was useful in detecting significant intra-abdominal injuries in trauma patients in our observation unit.
Methods:
We performed a retrospective chart review of all trauma patients placed in our observation unit over a 14-month period. Patients had received trauma surgery evaluation before placement in the observation unit and routinely received serial hematocrit testing (>or=2 hematocrit levels) while in the observation unit. We compared trauma patients with a hematocrit drop of 5 points or more to those without a significant hematocrit drop.
Results:
Three hundred sixty-five trauma patients were placed in the observation unit, and 310 patients (85%) had at least 2 hematocrits drawn during their stay. Of these patients, 20.6% had a hematocrit drop of 5 or more. Of patients with the hematocrit change, 18.8% were admitted to an inpatient unit from the observation unit compared to 9.3% of patients without a significant hematocrit change (P = .034). In one of these patients who had a computed tomography scan before observation admission, which demonstrated free fluid, the hematocrit drop assisted in diagnosing significant intra-abdominal injury.
Conclusion:
Although serial hematocrit testing may be useful in specific situations, routine use of serial hematocrit testing in trauma patients at a level I trauma center's observation unit did not significantly aid in the detection of occult injury.
