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Hypocalcemia in trauma patients: A systematic review
Mayank Vasudeva1, Joseph K Mathew, Christopher Groombridge
1From the National Trauma Research Institute, Alfred Health (M.V., J.K.M., C.G., J.W.T., C.S.J., A.M., M.C.F.); Emergency and Trauma Centre (M.V., C.G., C.S.J., A.M.), and Trauma Service (J.K.M., C.G., J.W.T., C.S.J., A.M., M.C.F.), The Alfred Hospital; Central Clinical School (J.K.M., M.C.F.), Monash University; Software & Innovation Lab (J.K.M., M.C.F.), Deakin University; and Department of Neurosurgery (J.W.T.), The Alfred Hospital, Melbourne, Australia.
Admission ionized hypocalcemia is common in trauma patients and linked to increased mortality, transfusion needs, and coagulopathy. Further research is needed to confirm these associations.
Area of Science:
- Trauma critical care
- Calcium homeostasis
- Hemostasis and thrombosis
Background:
- Hemorrhagic shock disrupts calcium-dependent pathways like platelet function, hemostasis, and cardiac contractility.
- Ionized hypocalcemia is a significant physiological derangement during shock and resuscitation.
- Understanding calcium's role is crucial for managing trauma patients.
Purpose of the Study:
- To systematically review literature associating pretransfusion/admission ionized hypocalcemia with outcomes in adult trauma patients.
- To examine the relationship between hypocalcemia and mortality, blood transfusion needs, and coagulopathy.
- To synthesize current evidence on the clinical significance of ionized calcium levels in trauma.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched Ovid MEDLINE and grey literature until May 2020; screened reference lists.
- Assessed study quality using the Newcastle-Ottawa Scale; excluded case reports/series.
Main Results:
- Six studies were included after screening 585 abstracts.
- Admission ionized hypocalcemia was observed in up to 56.2% of patients.
- Hypocalcemia correlated with increased mortality (3 studies), transfusion needs (2 studies), and coagulopathy (1 study).
Conclusions:
- Ionized hypocalcemia is prevalent in trauma patients experiencing shock.
- A significant association exists between admission hypocalcemia and adverse outcomes, including mortality, transfusion requirements, and coagulopathy.
- Prospective trials are necessary to validate these findings and guide clinical practice.
