Initial Calcium Derangements in Major Trauma and Outcomes

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.