Letter to the Editor
Reflections on the utility of excess bases as a marker in the prognosis of chest trauma in the geriatric population
Reflexiones sobre la utilidad del exceso de bases como marcador en el pronóstico del traumatismo torácico en la población geriátrica
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Peñasco, A. González-Castro, J.C. Rodríguez-Borregán, J. Llorca" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Y." "apellidos" => "Peñasco" "email" => array:1 [ 0 => "metalkender@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "González-Castro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Rodríguez-Borregán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Llorca" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Reflexiones sobre la utilidad del exceso de bases como marcador en el pronóstico del traumatismo torácico en la población geriátrica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with interest the comments made by Úbeda et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> following the publication of our article on the utility of excess bases in geriatric chest trauma.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In their letter, the authors the question the usefulness of this marker in the global context of acid-base status assessment in the light of other more accurate and prognostically valuable parameters. We take this opportunity to clarify a series of statements made in their letter.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Base excess has been widely used as a prognostic marker in many different clinical situations, including serious trauma. However, this marker in itself is far from ideal for a detailed assessment of severity in any context. Other markers have been shown to be more accurate in the assessment of critical patients when used alone.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a> However, this does not invalidate or diminish the usefulness of base excess in clinical practice.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Base excess is a quick test that can give results within a few minutes of starting the preliminary evaluation of the patient. This does not exclude in any way the need for a more thorough evaluation once the results of more detailed tests are available. However, as we all know, time is of the essence when managing a potentially serious disease, and therefore clinicians must know which tests can be useful at each stage of their evaluation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">There is no doubt that methods mentioned by Úbeda et al. give a more accurate picture of the status of the critically ill patient.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, they are more complex, time consuming, and costly. This is true of strong ion difference, the determination of non-volatile weak acids or SOFA scale score. Nevertheless, it is essential to perform these tests in parallel with or subsequent to excess base calculation</p><p id="par0025" class="elsevierStylePara elsevierViewall">There is strong evidence to support the usefulness of lactate as a prognostic marker in critical patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However, in trauma patients, serum lactate has been shown to peak later than base excess,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> although this, of course, does not mean that lactate determination will not be required if base excess has already been calculated. Moreover, both values could give a more comprehensive picture of the status of each patient.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Our study shows the utility of a −6<span class="elsevierStyleHsp" style=""></span>mmol/L base excess in a particular population (geriatric patients) in connection with a particular process (chest trauma) and in a specific clinical context (normal blood pressure ranges). We believe that base excess should be used in the evaluation of patients in this context, and not as a categorical, watertight parameter for excluding or including patients. Similarly, conventional chest x-ray can be a useful tool, even though there are other imaging techniques that may be more discriminatory in potentially serious injuries.</p><p id="par0035" class="elsevierStylePara elsevierViewall">With regard to the 20 patients without chest trauma, this was due to errors in their medical records. Although these errors were not analysed in each case, the patients did not present chest trauma, and therefore did not meet the inclusion criteria. We mentioned this in the article in order to clarify the methodological procedure used and the results obtained. However, because these patients did not meet the inclusion criteria, they were not included in the statistical analysis.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Some of the limitations of our study have been noted by Úbeda et al. Many are mentioned in the original article, such as the potential for bias arising from the origin of the patients (admitted to the ICU), the long duration of the study, and our failure to analyse the impact of comorbidity or the cause of death. We agree that it would be interesting to include other variables, such as the resuscitation measures used, or the time from injury to admission. However, many of these limitations are inherent to retrospective studies, and are due to several factors: the unavailability of certain variables, the sample selection method, or the need to extend the study period. Regarding OR data, in our article these are from the multivariate analysis, and are also shown in tables and figures.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To conclude, we are confident that base excess is a useful tool in the assessment of geriatric patients with severe chest trauma. Routine determination of this value can indicate occult hypoperfusion and help in the selection of patients who benefit from treatment in the ICU. However, determination of base excess does not exclude a more detailed analysis using other tools with a higher prognostic value. Likewise, controlled randomised studies are needed to help select patients with tissue hypoperfusion that could benefit from early intervention.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Peñasco Y, González-Castro A, Rodríguez-Borregán JC, Llorca J. Reflexiones sobre la utilidad del exceso de bases como marcador en el pronóstico del traumatismo torácico en la población geriátrica. 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