Hypocalcaemia and traumatic coagulopathy: an observational analysis

Area of Science:

• Trauma critical care
• Emergency medicine
• Clinical biochemistry

Background:

• Hemorrhage-associated calcium loss can impair platelet function, hemostasis, and cardiac contractility.
• Shocked major trauma patients are at risk for adverse outcomes due to calcium dysregulation.

Purpose of the Study:

• To investigate the association between admission hypocalcaemia and adverse outcomes in shocked major trauma patients.

Main Methods:

• Adult major trauma patients with shock index ≥1, presenting directly from the scene, were analyzed.
• Exclusion criteria included pre-hospital blood transfusion.
• Ionized hypocalcaemia (<1.11 mmol/l) and acute traumatic coagulopathy (INR >1.5) were defined.
• Multivariable logistic regression adjusted for injury severity, GCS, bicarbonate, and lactate was used.

Main Results:

• 50% of patients presented with ionized hypocalcaemia.
• Hypocalcaemia was independently associated with acute traumatic coagulopathy (aOR 2.9, P=0.048).
• Hypocalcaemic patients had higher rates of blood transfusion (62.5% vs 37.5%, P<0.001) and in-hospital mortality (25.6% vs 15.0%, P=0.047).

Conclusions:

• Admission hypocalcaemia is prevalent in shocked trauma patients and independently associated with acute traumatic coagulopathy.
• These findings suggest a potential benefit of early calcium administration in patients with hemorrhagic shock.
• Further research via randomized controlled trials is warranted to confirm the efficacy of protocolized calcium administration.