Base excess, a useful marker in the prognosis of chest trauma in the geriatric population | Revista Española de Anestesiología y Reanimación (English Edition)

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"apellidos" => "Llorca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exceso de bases, un marcador útil en el pronóstico del traumatismo torácico en la población geriátrica" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1219 "Ancho" => 1633 "Tamanyo" => 87289 ] ] "descripcion" => array:1 [ "en" => "Correlation of systolic blood pressure and base excess with mortality. Multivariate analysis showing OR and 95% CIs." ] ] ] "textoCompleto" => "IntroductionIn recent years, increased longevity has led to an increase in the number of elderly people in respect of the general population.<a class="elsevierStyleCrossRefs" href="#bib0110">1–3</a> Moreover, advances in the field of public health have improved the quality of life of individuals of increasingly advanced ages, leading to an increase in the number of elderly individuals with functional independence engaging in a high level of physical activity.<a class="elsevierStyleCrossRefs" href="#bib0125">4–6</a> In parallel with these developments, the number of geriatric individuals requiring hospital admission in connection with acute trauma has increased.<a class="elsevierStyleCrossRefs" href="#bib0110">1–3</a>The elderly population presents several characteristics derived from age-related changes, increased comorbidities and the need for long-term pharmacological treatment that differentiate it from younger individuals. All these are associated with an increased risk of complications and death following traumatic injury.<a class="elsevierStyleCrossRefs" href="#bib0115">2,3,7,8</a>The initial assessment of the trauma patient focuses on the detection of potentially life-threatening injuries. Traditionally, this aim of this initial triage is to classify the most stable patients by evaluating certain physiological variables.<a class="elsevierStyleCrossRef" href="#bib0150">9</a> However, it has been suggested that the presence of normal ranges of these physiological parameters may not indicate clinical stability in elderly individuals.<a class="elsevierStyleCrossRefs" href="#bib0155">10,11</a> For this reason, several authors have indicated that in this population signs of instability should be determined using different methods to those used to triage middle-aged individuals,<a class="elsevierStyleCrossRefs" href="#bib0165">12,13</a> and have even suggested that the normal ranges applied to the general population should be recalculated to adapt them to elderly patients.<a class="elsevierStyleCrossRefs" href="#bib0160">11–14</a>Specifically, increasing the systolic blood pressure cut-off point from the standard 90mmHg to a new level of 110mmHg in geriatric patients has been shown to improve detection of potential haemodynamic instability.<a class="elsevierStyleCrossRef" href="#bib0175">14</a> Moreover, the determination of base excess (BE) has been useful in detecting potentially unstable patients when no hypotension is present.<a class="elsevierStyleCrossRef" href="#bib0180">15</a> BE is a blood gas parameter for assessing the metabolic component of acid-base abnormalities by estimating the level of metabolic acidosis and the base needed to neutralise the balance. A negative value indicates the presence of metabolic acidosis, and the absolute value refers to the amount of base necessary to normalise blood pH.However, the usefulness of EB determinations in the absence of hypotension has been assessed on the basis of patients with an arterial pressure higher than 90mmHg.<a class="elsevierStyleCrossRef" href="#bib0180">15</a> Moreover, these observations were made in a general geriatric population, including patients presenting lesions at different levels, and without excluding those not considered candidates for intensive care measures.For these reasons, we conducted a study to evaluate the usefulness of determining EB in a cohort of elderly patients admitted to an intensive care unit (ICU) with a diagnosis of chest trauma.Material and methodAll patients aged 65 years or older diagnosed with chest trauma and admitted to the ICU of the Hospital Marqués de Valdecilla between 1 January 1991 and 1 January 2012 were included in the study.Each patient was followed up until the date of discharge or until the patient's death.Clinical and analytical findings and patient progress were reviewed retrospectively from the patient's medical records on file in the hospital. Reports from different hospital departments, progress reports, surgery reports and different analytical determinations were reviewed.Data were collected on data collection sheets to facilitate subsequent uploading to a computerised database and statistical processing.The primary objective of the study was the detection of greater intra-ICU mortality in patients presenting a laboratory finding of altered EB values without hypotension.The data were initially analysed descriptively. The results were shown as absolute frequency and percentage for categorical variables, and as mean, standard deviation, median, interquartile range and minimum and maximum values for continuous quantitative variables.Pearson's chi-square test or Fisher's exact test, depending on the expected value, were used to compare categorical data. The Student's t test was used to compare quantitative variables against categorical variables, except when the Levene test showed inequality of variances, in which case Welch's test was used. ANOVA, with a Dunnett post hoc test, was used to compare the means of categorical variables with more than 2 values.Finally, logistic regression was used to predict mortality. A univariate analysis was initially performed on each variable, followed by a multivariate analysis to control confounding factors. These confounders were identified on the basis of the existing medical literature and results of the univariate statistical analysis. After these tests, the year of admission to the ICU, patient age and sex, the initial severity determined by the APACHE II score, and the severity of the trauma measured on the ISS scale were included in the multivariate analysis.ResultsDuring the study period, 269 patients meeting the inclusion criteria were admitted to the ICU. Although we did not establish specific exclusion criteria for this study, after a review of the medical records 20 patients that did not present injuries consistent with chest trauma, despite the diagnosis on admission, were ultimately excluded.The clinical and haemodynamic characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Chest injuries presented were, in order of frequency: multiple rib fracture (80.72%), pneumothorax (34.14%), haemothorax (34.14%), pulmonary contusion (26.91%), flail chest (18.70%), haemopneumothorax (17.26%), single rib fracture (10.04%), myocardial contusion (5.62%), diaphragmatic injury (2.01%) and vascular injury (1.61%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Six patients (2.4%) required emergency surgery, 105 patients (42.16%) were treated by placing a chest tube, and conservative management was specified in 138 patients (55.42%).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Laboratory values and physiological variables at ICU admission are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Associated injuries were, in order of frequency: skeletal trauma (42.6%), head trauma (39.6%), pelvic trauma (27.2%), abdominal trauma (20.4%) and spinal trauma (16.6%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Four patients required emergency surgery for head injuries, representing 4.12% of all patients with head trauma.<elsevierMultimedia ident="fig0010"></elsevierMultimedia>In terms of ICU severity scales, mean APACHE II was 16.21±7.87, mean ISS was 24.45±14.16, and the mean Glasgow coma scale score was 2±4.Mean ICU stay was 12.74±16.85 days, and mean hospital stay was 26.55±30.1 days.With regard to mortality, 73 patients (29.32%) died in the ICU, and 84 (33.73%) died during their overall hospital stay, including the time spent in the ICU.Statistical analysis showed a correlation between blood pressure <110mmHg at admission and mortality, with an OR of 4.11 (95% CI, 1.91–8.85) compared to patients with blood pressure between 110 and 140mmHg. This correlation was statistically significant in the multivariate analysis. Patients with a <−6mmol/L BE in venous blood at admission also showed increased mortality compared to patients with higher values, with an OR of 3.12 (95% CI, 1.51–6.42). This correlation was also statistically significant.Finally, BE <−6mmol/L was also an indicator of higher mortality, with an OR of 4.93 (95% CI, 1.71–14.16) when the analysis was restricted to patients with blood pressure between 110 and 140mmHg. This result was statistically significant in the multivariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>DiscussionThe increase in the elderly population in recent decades, along with increased functional independence in this group, have been associated with an increase in the number of individuals aged 65 or over requiring hospital admission for trauma.<a class="elsevierStyleCrossRefs" href="#bib0110">1–6</a>The special characteristics of this patient population, such as age-related physiological changes, poor response to stress, greater comorbidities, and the frequent need for long-term pharmacological treatment, makes it particularly challenging to evaluate the severity of injury in these patients.<a class="elsevierStyleCrossRefs" href="#bib0115">2,3,7,8</a> Correct triage is essential in the initial care of the trauma patient. However, in the elderly population, the presence of physiological parameters in the normal range may not necessarily indicate clinical stability.<a class="elsevierStyleCrossRefs" href="#bib0155">10,11</a> Several authors have highlighted the need for a more detailed assessment in these patients in order to actively detect the presence of hypoperfusion that would otherwise remain occult.<a class="elsevierStyleCrossRefs" href="#bib0165">12,13</a> Specifically, one of the best indicators of hypoperfusion is BE, which estimates metabolic acidosis. Callaway et al. showed increased mortality associated with possible occult hypoperfusion in normotensive elderly trauma patients with an initial BE of less than −6mmol/L.<a class="elsevierStyleCrossRef" href="#bib0180">15</a>A recent study found an initial systolic pressure of 110mmHg instead of the standard 90mmHg<a class="elsevierStyleCrossRef" href="#bib0175">14</a> to be a better predictor of potential instability in geriatric patients. This suggests that the results presented by Callaway et al. could be influenced by the increased mortality in patients presenting systolic pressure of between 90 and 110mmHg, as these values are considered to be within the normal range.<a class="elsevierStyleCrossRef" href="#bib0180">15</a>However, these studies are based on data from elderly trauma patients, without excluding patients not considered candidates for intensive care.<a class="elsevierStyleCrossRefs" href="#bib0175">14,15</a> This is why the higher mortality reported by these authors could be related to the use end of life care, a measure that is more frequent in this population.<a class="elsevierStyleCrossRef" href="#bib0185">16</a>Our study focuses on a cohort of elderly patients diagnosed with chest trauma that required ICU admission. For reasons of study design, patients not considered candidates for intensive care were excluded from the study. Moreover, based on the results of recent studies,<a class="elsevierStyleCrossRef" href="#bib0175">14</a> normotension was defined as systolic pressure >110mmHg. Finally, the cut-off point for altered BE was −6mmol/L. This was chosen for 2 reasons: on the one hand, this was the value previously used in normotensive elderly patients admitted for trauma,<a class="elsevierStyleCrossRef" href="#bib0180">15</a> and on the other, we believe that using the same cut-off point will allow us to corroborate the claim by Callaway et al. that normotensive levels should be revised in the elderly population.<a class="elsevierStyleCrossRefs" href="#bib0175">14,15</a>Our results show higher mortality among normotensive patients presenting BE <−6mmol/L, even after excluding patients not considered candidates for intensive care, and basing our normotension criteria on the findings of the latest studies. This proves the usefulness of this parameter in the initial assessment of these patients, and is in line with previous studies that raise the need to find different methods from arterial blood pressure for evaluating the presence of occult hypoperfusion.<a class="elsevierStyleCrossRefs" href="#bib0165">12,13,15</a>In our study, patients aged over 65 years were considered geriatric. Although there is no standard age at which a trauma patient is considered a candidate for geriatric care, 65 years is the cut-off used in most studies.<a class="elsevierStyleCrossRefs" href="#bib0190">17–19</a>Our study is limited insofar as we focussed exclusively on patients admitted to the ICU with a diagnosis of chest trauma, regardless of other diagnoses. For this reason, our results are only applicable to this population, and further studies are needed to evaluate this parameter in other clinical situations. However, our results suggest that routine measurement of this parameter can help detect certain patients who would benefit from treatment in an ICU, even when they appear to present respiratory and haemodynamic stability.We collected data from patients admitted from 1991 to 2012, a particularly long period. To counterbalance this effect, we included the year of admission to the ICU in the multivariate analysis as a confounding factor. Despite this statistical correction, it is difficult to control other factors that may alter these results, and these patients needed to be included in order to obtain the required statistical power. The number of patients admitted with these characteristics is similar to that reported in other studies that are similar to ours in terms of patient characteristics and time frame.<a class="elsevierStyleCrossRefs" href="#bib0205">20,21</a>Finally, we did not evaluate the cause of death or the impact of comorbidities or other injuries on the evolution of our patients. The presence of comorbidities was specifically not assessed due to the small number of patients with advanced disease. Other injuries were assessed globally by ISS score, and this variable was included in the multivariate analysis. Other factors that could have influenced BE at the time of admission, such as haemoglobin levels, were not included in the multivariate analysis because they are already included in the APACHE II score used to assess our patients.In conclusion, the presence of a BE level of less than −6mmol/L is associated with increased mortality in elderly patients with a baseline blood pressure level of between 110 and 140mmHg, diagnosed with chest trauma and requiring admission to an ICU. Routine measurement of this parameter in this population could be valuable in unmasking occult hypoperfusion, and may be a useful marker in the selection of patients who would benefit from ICU treatment.Ethical responsibilitiesProtection of human and animal rightsThe authors declare that no experiments were performed on humans or animals for this study.Data confidentialityThe authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications.Right to privacy and informed consentThe authors declare that no patient data appears in this article.Conflict of interestsThe authors declare they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres833119" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec829029" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres833120" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec829030" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0025" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Protection of human and animal rights" ] 1 => array:2 [ "identificador" => "sec0035" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-09-06" "fechaAceptado" => "2016-11-17" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec829029" "palabras" => array:3 [ 0 => "Chest trauma" 1 => "Prognostic index" 2 => "Base excess" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec829030" "palabras" => array:3 [ 0 => "Traumatismo torácico" 1 => "Índice pronóstico" 2 => "Exceso de bases" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo determine the usefulness of the determination of base excess in a cohort of elderly patients admitted to an intensive care unit (ICU) with a diagnosis of chest trauma. Material and methodTwo hundred and forty-nine patients were included aged 65 years and over with a diagnosis of thoracic trauma who required admission to the ICU. We made a statistical analysis in order to determine the association of the first base excess levels with mortality during the unit stay. ResultsTwo hundred and forty-nine patients, with a mean APACHE II score of 16.21±7.87 and 24.45±14.16 ISS. Mean ICU stay was 12.74±16.85 days and the mean hospital stay was 26.55±30.1 days. Statistical analysis showed an association with mortality in patients whose blood pressure was lower than 110mmHg on admission, with an OR=4.11 (95% CI 1.91–8.85) compared to patients with blood pressure between 110 and 140mmHg. Those patients who had base excess levels on admission of less than −6mmol/L also showed increased mortality compared to patients with higher levels, with an OR=3.12 (95% CI 1.51–6.42). ConclusionsThe presence of a base excess level of less than −6 is associated with increased mortality in elderly patients with initial blood pressure between 110 and 140mmHg, diagnosed with thoracic trauma and who require admission to ICU. Routine measurement of this parameter in this population may show the clinical usefulness of assessing possible hidden hypoperfusion." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoPrecisar la utilidad de la determinación del exceso de bases en una cohorte de enfermos geriátricos que ingresaron en una unidad de cuidados intensivos (UCI) con diagnóstico de traumatismo torácico. Material y métodoSe incluyeron 249 enfermos con una edad igual o mayor de 65 años y diagnóstico de traumatismo torácico que precisaron ingreso en la UCI. Se realizó un análisis estadístico con el objetivo de determinar la asociación del valor de la primera determinación del exceso de bases con la mortalidad durante la estancia en la unidad. ResultadosSe analizaron 249 enfermos, con un valor medio de APACHE II de 16,21±7,87 y un ISS de 24,45±14,16. La estancia en UCI fue de 12,74±16,85 días y la estancia hospitalaria media de 26,55±30,1 días. El análisis estadístico mostró una asociación con la mortalidad en aquellos pacientes que presentaron un valor de presión arterial al ingreso inferior a 110mmHg, con una OR de 4,11 (IC 95% 1,91-8,85) respecto a los pacientes con presión arterial entre 110 y 140mmHg. Aquellos pacientes que presentaron un valor de exceso de bases al ingreso inferior a −6mmol/L también mostraron mayor mortalidad respecto a los pacientes con valores mayores, con una OR de 3,12 (IC 95% 1,51-6,42). ConclusionesLa presencia de un valor de exceso de bases inferior a −6 se asocia con una mayor mortalidad en los pacientes ancianos con cifras iniciales de presión arterial entre 110 y 140mmHg, con diagnóstico de traumatismo torácico y que precisan un ingreso en una UCI. La medición rutinaria de este parámetro en este tipo de población podría mostrar utilidad clínica para la valoración de una posible hipoperfusión oculta." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Peñasco Y, González-Castro A, Rodríguez-Borregán JC, Llorca J. Exceso de bases, un marcador útil en el pronóstico del traumatismo torácico en la población geriátrica. Rev Esp Anestesiol Reanim. 2017;64:250–256." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1049 "Ancho" => 1603 "Tamanyo" => 90251 ] ] "descripcion" => array:1 [ "en" => "Specific chest injuries among study patients (percentage of patients)." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 966 "Ancho" => 1630 "Tamanyo" => 59404 ] ] "descripcion" => array:1 [ "en" => "Percentage of patients presenting injuries in different anatomical regions concomitant with chest trauma." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1219 "Ancho" => 1633 "Tamanyo" => 87289 ] ] "descripcion" => array:1 [ "en" => "Correlation of systolic blood pressure and base excess with mortality. Multivariate analysis showing OR and 95% CIs." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Score \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean±SD/n (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">74.5±6.87 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Men \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">152 (64.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Comorbidities</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Liver failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (1.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">COPD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26 (11.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">45 (19.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">33 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Coagulopathy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chronic kidney failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malignancy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Immunodeficiency \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">73 (31.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Reason for admission</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neurological impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 (18.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory failure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25 (10.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Haemodynamic instability \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">61 (26) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Clinical monitoring \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">105 (44.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Injury mechanism</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Traffic accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">63 (26.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pedestrian accident \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">87 (37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fall from height \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (15.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Fall \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30 (12.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Assault \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1 (0.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">17 (7.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top">Associated injuries</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Head injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 (39.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Abdominal injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 (20.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pelvic injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">64 (27.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Spinal injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39 (16.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Skeletal injury \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100 (42.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403307.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Clinical and demographic characteristics of patients at ICU admission." ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Score \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean±SD \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart rate (bpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.3±24.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118.36±34.78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DAP (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.48±20.52 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory rate (rpm) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.89±6.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temp (°C) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35.79±0.86 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hb (g/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.15±3.37 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hct (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.79±8.48 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White cells/mm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14,333±6.092 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets/mm3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">183,235±82,713 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ATP (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.30±24.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">189.52±157.64 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53.32±25.40 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine (mg/dL) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.27±1.15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.16±0.19 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Base excess (mmol/L) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−2.78±4.77 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pCO2 (mmHg) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44.91±10.68 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403306.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Analytical values and physiological variables at admission to ICU." ] ] 5 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Multivariate analysis: adjusted for age (continuous variable), sex (dichotomous variable), ISS score (continuous variable), APACHE II score (continuous variable) and year of admission to ICU intensive (continuous variable)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Systolic arterial pressure</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">110–140mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><110mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.91–8.85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>140mmHg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.17–3.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.706 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Base excess</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥−6mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><−6mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51–6.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Base excess in patients with systolic arterial pressure between 110 and 140mmHg</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">≥−6mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><−6mmol/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.71–14.16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1403308.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation of systolic blood pressure and base excess with mortality, as an OR. 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Original Article

Base excess, a useful marker in the prognosis of chest trauma in the geriatric population

Exceso de bases, un marcador útil en el pronóstico del traumatismo torácico en la población geriátrica

Y. Peñascoa,

Corresponding author

metalkender@yahoo.es

Corresponding author.

, A. González-Castroa, J.C. Rodríguez-Borregána, J. Llorcab

a Departamento de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain

b Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Spain

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    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Base excess&#44; a useful marker in the prognosis of chest trauma in the geriatric population"
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        "titulo" => "Exceso de bases&#44; un marcador &#250;til en el pron&#243;stico del traumatismo tor&#225;cico en la poblaci&#243;n geri&#225;trica"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation of systolic blood pressure and base excess with mortality&#46; Multivariate analysis showing OR and 95&#37; CIs&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years&#44; increased longevity has led to an increase in the number of elderly people in respect of the general population&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;3</span></a> Moreover&#44; advances in the field of public health have improved the quality of life of individuals of increasingly advanced ages&#44; leading to an increase in the number of elderly individuals with functional independence engaging in a high level of physical activity&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">4&#8211;6</span></a> In parallel with these developments&#44; the number of geriatric individuals requiring hospital admission in connection with acute trauma has increased&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The elderly population presents several characteristics derived from age-related changes&#44; increased comorbidities and the need for long-term pharmacological treatment that differentiate it from younger individuals&#46; All these are associated with an increased risk of complications and death following traumatic injury&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;3&#44;7&#44;8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The initial assessment of the trauma patient focuses on the detection of potentially life-threatening injuries&#46; Traditionally&#44; this aim of this initial triage is to classify the most stable patients by evaluating certain physiological variables&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">9</span></a> However&#44; it has been suggested that the presence of normal ranges of these physiological parameters may not indicate clinical stability in elderly individuals&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;11</span></a> For this reason&#44; several authors have indicated that in this population signs of instability should be determined using different methods to those used to triage middle-aged individuals&#44;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;13</span></a> and have even suggested that the normal ranges applied to the general population should be recalculated to adapt them to elderly patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">11&#8211;14</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Specifically&#44; increasing the systolic blood pressure cut-off point from the standard 90<span class="elsevierStyleHsp" style=""></span>mmHg to a new level of 110<span class="elsevierStyleHsp" style=""></span>mmHg in geriatric patients has been shown to improve detection of potential haemodynamic instability&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> Moreover&#44; the determination of base excess &#40;BE&#41; has been useful in detecting potentially unstable patients when no hypotension is present&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> BE is a blood gas parameter for assessing the metabolic component of acid-base abnormalities by estimating the level of metabolic acidosis and the base needed to neutralise the balance&#46; A negative value indicates the presence of metabolic acidosis&#44; and the absolute value refers to the amount of base necessary to normalise blood pH&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; the usefulness of EB determinations in the absence of hypotension has been assessed on the basis of patients with an arterial pressure higher than 90<span class="elsevierStyleHsp" style=""></span>mmHg&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> Moreover&#44; these observations were made in a general geriatric population&#44; including patients presenting lesions at different levels&#44; and without excluding those not considered candidates for intensive care measures&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">For these reasons&#44; we conducted a study to evaluate the usefulness of determining EB in a cohort of elderly patients admitted to an intensive care unit &#40;ICU&#41; with a diagnosis of chest trauma&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><p id="par0035" class="elsevierStylePara elsevierViewall">All patients aged 65 years or older diagnosed with chest trauma and admitted to the ICU of the Hospital Marqu&#233;s de Valdecilla between 1 January 1991 and 1 January 2012 were included in the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Each patient was followed up until the date of discharge or until the patient&#39;s death&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinical and analytical findings and patient progress were reviewed retrospectively from the patient&#39;s medical records on file in the hospital&#46; Reports from different hospital departments&#44; progress reports&#44; surgery reports and different analytical determinations were reviewed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Data were collected on data collection sheets to facilitate subsequent uploading to a computerised database and statistical processing&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The primary objective of the study was the detection of greater intra-ICU mortality in patients presenting a laboratory finding of altered EB values without hypotension&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The data were initially analysed descriptively&#46; The results were shown as absolute frequency and percentage for categorical variables&#44; and as mean&#44; standard deviation&#44; median&#44; interquartile range and minimum and maximum values for continuous quantitative variables&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Pearson&#39;s chi-square test or Fisher&#39;s exact test&#44; depending on the expected value&#44; were used to compare categorical data&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span> test was used to compare quantitative variables against categorical variables&#44; except when the Levene test showed inequality of variances&#44; in which case Welch&#39;s test was used&#46; ANOVA&#44; with a Dunnett post hoc test&#44; was used to compare the means of categorical variables with more than 2 values&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Finally&#44; logistic regression was used to predict mortality&#46; A univariate analysis was initially performed on each variable&#44; followed by a multivariate analysis to control confounding factors&#46; These confounders were identified on the basis of the existing medical literature and results of the univariate statistical analysis&#46; After these tests&#44; the year of admission to the ICU&#44; patient age and sex&#44; the initial severity determined by the APACHE II score&#44; and the severity of the trauma measured on the ISS scale were included in the multivariate analysis&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">During the study period&#44; 269 patients meeting the inclusion criteria were admitted to the ICU&#46; Although we did not establish specific exclusion criteria for this study&#44; after a review of the medical records 20 patients that did not present injuries consistent with chest trauma&#44; despite the diagnosis on admission&#44; were ultimately excluded&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The clinical and haemodynamic characteristics of the patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Chest injuries presented were&#44; in order of frequency&#58; multiple rib fracture &#40;80&#46;72&#37;&#41;&#44; pneumothorax &#40;34&#46;14&#37;&#41;&#44; haemothorax &#40;34&#46;14&#37;&#41;&#44; pulmonary contusion &#40;26&#46;91&#37;&#41;&#44; flail chest &#40;18&#46;70&#37;&#41;&#44; haemopneumothorax &#40;17&#46;26&#37;&#41;&#44; single rib fracture &#40;10&#46;04&#37;&#41;&#44; myocardial contusion &#40;5&#46;62&#37;&#41;&#44; diaphragmatic injury &#40;2&#46;01&#37;&#41; and vascular injury &#40;1&#46;61&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Six patients &#40;2&#46;4&#37;&#41; required emergency surgery&#44; 105 patients &#40;42&#46;16&#37;&#41; were treated by placing a chest tube&#44; and conservative management was specified in 138 patients &#40;55&#46;42&#37;&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Laboratory values and physiological variables at ICU admission are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Associated injuries were&#44; in order of frequency&#58; skeletal trauma &#40;42&#46;6&#37;&#41;&#44; head trauma &#40;39&#46;6&#37;&#41;&#44; pelvic trauma &#40;27&#46;2&#37;&#41;&#44; abdominal trauma &#40;20&#46;4&#37;&#41; and spinal trauma &#40;16&#46;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Four patients required emergency surgery for head injuries&#44; representing 4&#46;12&#37; of all patients with head trauma&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">In terms of ICU severity scales&#44; mean APACHE II was 16&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;87&#44; mean ISS was 24&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;16&#44; and the mean Glasgow coma scale score was 2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Mean ICU stay was 12&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;85 days&#44; and mean hospital stay was 26&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;1 days&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">With regard to mortality&#44; 73 patients &#40;29&#46;32&#37;&#41; died in the ICU&#44; and 84 &#40;33&#46;73&#37;&#41; died during their overall hospital stay&#44; including the time spent in the ICU&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Statistical analysis showed a correlation between blood pressure &#60;110<span class="elsevierStyleHsp" style=""></span>mmHg at admission and mortality&#44; with an OR of 4&#46;11 &#40;95&#37; CI&#44; 1&#46;91&#8211;8&#46;85&#41; compared to patients with blood pressure between 110 and 140<span class="elsevierStyleHsp" style=""></span>mmHg<span class="elsevierStyleMonospace">&#46;</span> This correlation was statistically significant in the multivariate analysis&#46; Patients with a &#60;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L BE in venous blood at admission also showed increased mortality compared to patients with higher values&#44; with an OR of 3&#46;12 &#40;95&#37; CI&#44; 1&#46;51&#8211;6&#46;42&#41;&#46; This correlation was also statistically significant&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Finally&#44; BE &#60;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L was also an indicator of higher mortality&#44; with an OR of 4&#46;93 &#40;95&#37; CI&#44; 1&#46;71&#8211;14&#46;16&#41; when the analysis was restricted to patients with blood pressure between 110 and 140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; This result was statistically significant in the multivariate analysis &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> and <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">The increase in the elderly population in recent decades&#44; along with increased functional independence in this group&#44; have been associated with an increase in the number of individuals aged 65 or over requiring hospital admission for trauma&#46;<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">1&#8211;6</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">The special characteristics of this patient population&#44; such as age-related physiological changes&#44; poor response to stress&#44; greater comorbidities&#44; and the frequent need for long-term pharmacological treatment&#44; makes it particularly challenging to evaluate the severity of injury in these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">2&#44;3&#44;7&#44;8</span></a> Correct triage is essential in the initial care of the trauma patient&#46; However&#44; in the elderly population&#44; the presence of physiological parameters in the normal range may not necessarily indicate clinical stability&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">10&#44;11</span></a> Several authors have highlighted the need for a more detailed assessment in these patients in order to actively detect the presence of hypoperfusion that would otherwise remain occult&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;13</span></a> Specifically&#44; one of the best indicators of hypoperfusion is BE&#44; which estimates metabolic acidosis&#46; Callaway et al&#46; showed increased mortality associated with possible occult hypoperfusion in normotensive elderly trauma patients with an initial BE of less than &#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A recent study found an initial systolic pressure of 110<span class="elsevierStyleHsp" style=""></span>mmHg instead of the standard 90<span class="elsevierStyleHsp" style=""></span>mmHg<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> to be a better predictor of potential instability in geriatric patients&#46; This suggests that the results presented by Callaway et al&#46; could be influenced by the increased mortality in patients presenting systolic pressure of between 90 and 110<span class="elsevierStyleHsp" style=""></span>mmHg<span class="elsevierStyleMonospace">&#44;</span> as these values are considered to be within the normal range&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">However&#44; these studies are based on data from elderly trauma patients&#44; without excluding patients not considered candidates for intensive care&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#44;15</span></a> This is why the higher mortality reported by these authors could be related to the use end of life care&#44; a measure that is more frequent in this population&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">16</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Our study focuses on a cohort of elderly patients diagnosed with chest trauma that required ICU admission&#46; For reasons of study design&#44; patients not considered candidates for intensive care were excluded from the study&#46; Moreover&#44; based on the results of recent studies&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">14</span></a> normotension was defined as systolic pressure &#62;110<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Finally&#44; the cut-off point for altered BE was &#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#46; This was chosen for 2 reasons&#58; on the one hand&#44; this was the value previously used in normotensive elderly patients admitted for trauma&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">15</span></a> and on the other&#44; we believe that using the same cut-off point will allow us to corroborate the claim by Callaway et al&#46; that normotensive levels should be revised in the elderly population&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">14&#44;15</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Our results show higher mortality among normotensive patients presenting BE &#60;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&#44; even after excluding patients not considered candidates for intensive care&#44; and basing our normotension criteria on the findings of the latest studies&#46; This proves the usefulness of this parameter in the initial assessment of these patients&#44; and is in line with previous studies that raise the need to find different methods from arterial blood pressure for evaluating the presence of occult hypoperfusion&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">12&#44;13&#44;15</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In our study&#44; patients aged over 65 years were considered geriatric&#46; Although there is no standard age at which a trauma patient is considered a candidate for geriatric care&#44; 65 years is the cut-off used in most studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">17&#8211;19</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our study is limited insofar as we focussed exclusively on patients admitted to the ICU with a diagnosis of chest trauma&#44; regardless of other diagnoses&#46; For this reason&#44; our results are only applicable to this population&#44; and further studies are needed to evaluate this parameter in other clinical situations&#46; However&#44; our results suggest that routine measurement of this parameter can help detect certain patients who would benefit from treatment in an ICU&#44; even when they appear to present respiratory and haemodynamic stability&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">We collected data from patients admitted from 1991 to 2012&#44; a particularly long period&#46; To counterbalance this effect&#44; we included the year of admission to the ICU in the multivariate analysis as a confounding factor&#46; Despite this statistical correction&#44; it is difficult to control other factors that may alter these results&#44; and these patients needed to be included in order to obtain the required statistical power&#46; The number of patients admitted with these characteristics is similar to that reported in other studies that are similar to ours in terms of patient characteristics and time frame&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">20&#44;21</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">Finally&#44; we did not evaluate the cause of death or the impact of comorbidities or other injuries on the evolution of our patients&#46; The presence of comorbidities was specifically not assessed due to the small number of patients with advanced disease&#46; Other injuries were assessed globally by ISS score&#44; and this variable was included in the multivariate analysis&#46; Other factors that could have influenced BE at the time of admission&#44; such as haemoglobin levels&#44; were not included in the multivariate analysis because they are already included in the APACHE II score used to assess our patients&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">In conclusion&#44; the presence of a BE level of less than &#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L is associated with increased mortality in elderly patients with a baseline blood pressure level of between 110 and 140<span class="elsevierStyleHsp" style=""></span>mmHg&#44; diagnosed with chest trauma and requiring admission to an ICU&#46; Routine measurement of this parameter in this population could be valuable in unmasking occult hypoperfusion&#44; and may be a useful marker in the selection of patients who would benefit from ICU treatment&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical responsibilities</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal rights</span><p id="par0180" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data confidentiality</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols implemented in their place of work regarding the use of patient data in publications&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "sec0010"
          "titulo" => "Material and method"
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        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        8 => array:3 [
          "identificador" => "sec0025"
          "titulo" => "Ethical responsibilities"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Protection of human and animal rights"
            ]
            1 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Data confidentiality"
            ]
            2 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        9 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conflict of interests"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-09-06"
    "fechaAceptado" => "2016-11-17"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec829029"
          "palabras" => array:3 [
            0 => "Chest trauma"
            1 => "Prognostic index"
            2 => "Base excess"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec829030"
          "palabras" => array:3 [
            0 => "Traumatismo tor&#225;cico"
            1 => "&#205;ndice pron&#243;stico"
            2 => "Exceso de bases"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the usefulness of the determination of base excess in a cohort of elderly patients admitted to an intensive care unit &#40;ICU&#41; with a diagnosis of chest trauma&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Two hundred and forty-nine patients were included aged 65 years and over with a diagnosis of thoracic trauma who required admission to the ICU&#46; We made a statistical analysis in order to determine the association of the first base excess levels with mortality during the unit stay&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Two hundred and forty-nine patients&#44; with a mean APACHE II score of 16&#46;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;87 and 24&#46;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#46;16 ISS&#46; Mean ICU stay was 12&#46;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;85 days and the mean hospital stay was 26&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#46;1 days&#46; Statistical analysis showed an association with mortality in patients whose blood pressure was lower than 110<span class="elsevierStyleHsp" style=""></span>mmHg on admission&#44; with an OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#46;11 &#40;95&#37; CI 1&#46;91&#8211;8&#46;85&#41; compared to patients with blood pressure between 110 and 140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Those patients who had base excess levels on admission of less than &#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L also showed increased mortality compared to patients with higher levels&#44; with an OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;12 &#40;95&#37; CI 1&#46;51&#8211;6&#46;42&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The presence of a base excess level of less than &#8722;6 is associated with increased mortality in elderly patients with initial blood pressure between 110 and 140<span class="elsevierStyleHsp" style=""></span>mmHg&#44; diagnosed with thoracic trauma and who require admission to ICU&#46; Routine measurement of this parameter in this population may show the clinical usefulness of assessing possible hidden hypoperfusion&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and method"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Precisar la utilidad de la determinaci&#243;n del exceso de bases en una cohorte de enfermos geri&#225;tricos que ingresaron en una unidad de cuidados intensivos &#40;UCI&#41; con diagn&#243;stico de traumatismo tor&#225;cico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 249 enfermos con una edad igual o mayor de 65 a&#241;os y diagn&#243;stico de traumatismo tor&#225;cico que precisaron ingreso en la UCI&#46; Se realiz&#243; un an&#225;lisis estad&#237;stico con el objetivo de determinar la asociaci&#243;n del valor de la primera determinaci&#243;n del exceso de bases con la mortalidad durante la estancia en la unidad&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 249 enfermos&#44; con un valor medio de APACHE II de 16&#44;21<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#44;87 y un ISS de 24&#44;45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;16&#46; La estancia en UCI fue de 12&#44;74<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;85 d&#237;as y la estancia hospitalaria media de 26&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30&#44;1 d&#237;as&#46; El an&#225;lisis estad&#237;stico mostr&#243; una asociaci&#243;n con la mortalidad en aquellos pacientes que presentaron un valor de presi&#243;n arterial al ingreso inferior a 110<span class="elsevierStyleHsp" style=""></span>mmHg&#44; con una OR de 4&#44;11 &#40;IC 95&#37; 1&#44;91-8&#44;85&#41; respecto a los pacientes con presi&#243;n arterial entre 110 y 140<span class="elsevierStyleHsp" style=""></span>mmHg&#46; Aquellos pacientes que presentaron un valor de exceso de bases al ingreso inferior a &#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L tambi&#233;n mostraron mayor mortalidad respecto a los pacientes con valores mayores&#44; con una OR de 3&#44;12 &#40;IC 95&#37; 1&#44;51-6&#44;42&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La presencia de un valor de exceso de bases inferior a &#8722;6 se asocia con una mayor mortalidad en los pacientes ancianos con cifras iniciales de presi&#243;n arterial entre 110 y 140<span class="elsevierStyleHsp" style=""></span>mmHg&#44; con diagn&#243;stico de traumatismo tor&#225;cico y que precisan un ingreso en una UCI&#46; La medici&#243;n rutinaria de este par&#225;metro en este tipo de poblaci&#243;n podr&#237;a mostrar utilidad cl&#237;nica para la valoraci&#243;n de una posible hipoperfusi&#243;n oculta&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0025"
            "titulo" => "Objetivo"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
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      ]
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Pe&#241;asco Y&#44; Gonz&#225;lez-Castro A&#44; Rodr&#237;guez-Borreg&#225;n JC&#44; Llorca J&#46; Exceso de bases&#44; un marcador &#250;til en el pron&#243;stico del traumatismo tor&#225;cico en la poblaci&#243;n geri&#225;trica&#46; Rev Esp Anestesiol Reanim&#46; 2017&#59;64&#58;250&#8211;256&#46;</p>"
      ]
    ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Specific chest injuries among study patients &#40;percentage of patients&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Percentage of patients presenting injuries in different anatomical regions concomitant with chest trauma&#46;</p>"
        ]
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        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation of systolic blood pressure and base excess with mortality&#46; Multivariate analysis showing OR and 95&#37; CIs&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#47;n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;years&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Men</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152 &#40;64&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Liver failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;1&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>COPD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;11&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heart disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Coagulopathy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;5&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Chronic kidney failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malignancy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;3&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immunodeficiency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;31&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reason for admission</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Neurological impairment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;18&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Respiratory failure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;10&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Haemodynamic instability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Clinical monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">105 &#40;44&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Injury mechanism</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Traffic accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63 &#40;26&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pedestrian accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87 &#40;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fall from height&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;15&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fall&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;12&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Assault&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Others&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Associated injuries</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Head injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 &#40;39&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abdominal injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;20&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pelvic injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64 &#40;27&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Spinal injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39 &#40;16&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skeletal injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 &#40;42&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Clinical and demographic characteristics of patients at ICU admission&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Heart rate &#40;bpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">SAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#46;36<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>34&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">DAP &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Respiratory rate &#40;rpm&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;89<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Temp &#40;&#176;C&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hb &#40;g&#47;dl&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;15<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hct &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32&#46;79<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#46;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">White cells&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#44;333<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#46;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Platelets&#47;mm<span class="elsevierStyleSup">3</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">183&#44;235<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>82&#44;713&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">ATP &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;30<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Glucose &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">189&#46;52<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>157&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urea &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53&#46;32<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Creatinine &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;27<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;16<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Base excess &#40;mmol&#47;L&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;2&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">pCO<span class="elsevierStyleInf">2</span> &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;91<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Analytical values and physiological variables at admission to ICU&#46;</p>"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis&#58; adjusted for age &#40;continuous variable&#41;&#44; sex &#40;dichotomous variable&#41;&#44; ISS score &#40;continuous variable&#41;&#44; APACHE II score &#40;continuous variable&#41; and year of admission to ICU intensive &#40;continuous variable&#41;&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Systolic arterial pressure</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>110&#8211;140<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;110<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;91&#8211;8&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;140<span class="elsevierStyleHsp" style=""></span>mmHg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17&#8211;3&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;706&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Base excess</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;51&#8211;6&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Base excess in patients with systolic arterial pressure between 110 and 140</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">mmHg</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8805;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="3" align="center" valign="top">Reference</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;&#8722;6<span class="elsevierStyleHsp" style=""></span>mmol&#47;L&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;71&#8211;14&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Correlation of systolic blood pressure and base excess with mortality&#44; as an OR&#46; Multivariate analysis&#46;</p>"
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      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advancing age and trauma&#58; triage destination compliance and mortality in Victoria&#44; Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Cox"
                            1 => "C&#46; Morrison"
                            2 => "P&#46; Cameron"
                            3 => "K&#46; Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2014.02.028"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2014"
                        "volumen" => "45"
                        "paginaInicial" => "1312"
                        "paginaFinal" => "1319"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24630836"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predicting hospital discharge disposition in geriatric trauma patients&#58; is frailty the answer&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "B&#46; Joseph"
                            1 => "V&#46; Pandit"
                            2 => "P&#46; Rhee"
                            3 => "H&#46; Aziz"
                            4 => "M&#46; Sadoun"
                            5 => "J&#46; Wynne"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/TA.0b013e3182a833ac"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trauma Acute Care Surg"
                        "fecha" => "2014"
                        "volumen" => "76"
                        "paginaInicial" => "196"
                        "paginaFinal" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24368379"
                            "web" => "Medline"
                          ]
                        ]
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Article information

ISSN: 23411929
Original language: English

DOI:10.1016/j.redare.2017.03.003

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