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Initial Calcium Derangements in Major Trauma and Outcomes.

Steven G Schauer1,2,3, Susannah E Nicholson4, Julie A Rizzo5

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Trauma patients frequently experience calcium imbalances upon emergency department arrival. Both hypocalcemia and hypercalcemia are linked to increased mortality and higher blood product use compared to normal calcium levels.

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Area of Science:

  • Trauma Care
  • Emergency Medicine
  • Clinical Biochemistry

Background:

  • Calcium derangements are common in trauma patients, often associated with transfusions.
  • Limited data exist on calcium levels upon initial trauma presentation and their impact.
  • Existing evidence suggests worse outcomes for trauma patients with calcium imbalances.

Purpose of the Study:

  • To determine the incidence of calcium derangements upon emergency department (ED) arrival after major trauma.
  • To investigate the association between calcium derangements and patient outcomes.

Main Methods:

  • Prospective, multicenter cohort study involving 1270 major trauma patients across 3 level I trauma centers.
  • Ionized calcium levels were measured immediately upon ED arrival.
  • Hypocalcemia, eucalcemia, and hypercalcemia were defined using a standard reference range.

Main Results:

  • The incidence of calcium derangements was 22% hypocalcemia, 73% eucalcemia, and 5% hypercalcemia.
  • Mortality rates at 24 hours were 11.9% for hypocalcemia, 4.3% for eucalcemia, and 22.8% for hypercalcemia.
  • A U-shaped relationship was observed between calcium levels and mortality; hypercalcemia showed the worst outcomes.

Conclusions:

  • Calcium derangements, including hypercalcemia, are prevalent upon ED arrival in major trauma patients.
  • Both hypocalcemia and hypercalcemia are associated with increased mortality and higher blood product consumption.
  • Further research, including prospective interventional trials, is needed to guide empiric treatment strategies.