Occult hypoperfusion in trauma patients : A systematic review on age-specific clinical outcome

Abstract text (incl. references and figure legends)

Introduction Occult hypoperfusion (OH) is defined as inadequate tissue oxygenation in the presence of normal vital signs. This condition is associated with impaired outcome in trauma, however the impact of age is unclear. This study aimed to assess outcome of OH in both young and elderly trauma patients.

Material & Methods A systematic Medline literature search was conducted using MeSH terms. Studies reporting on occult hypoperfusion in adult trauma patients were accessed. All studies that clearly stated clinical outcome of OH vs. a control condition were included.

Results 43 publications were identified by the MeSH-search, of whom 4 studies (n=3,334) reported on clinical outcome in OH. Average ISS varied between 7-28. Relative odds for mortality or major complications were higher in OH-situations than in normal conditions. If lactate levels are corrected within 24hrs, mortality is not increased in adult (age 43 ± 19) polytrauma patients with OH. In patients > 65yrs, OH was associated with higher mortality and prolonged ICU-stay. In young patients, relative odds for mortality/ complications are lower in OH than in shock conditions (OR 0.52;95%CI:0.42-0.65). However, in patients aged ≥ 55 years, relative odds for mortality/complications is higher in OH than in shock-conditions (OR 1.21;95%CI:0.97-1.52). The need for lifesaving intervention did not differ between OH and shock conditions in burn patients.

Conclusions Literature on age-specific outcome of occult hypoperfusion in trauma is sparse. However, findings indicate that OH is associated with impaired outcome in trauma patients of every age. Prompt correction of lactate seems to optimize outcome in younger patients with OH. Furthermore, the negative impact of OH on outcome is more profound in older than in younger trauma patients. Therefore, future studies should focus on prompt identification and treatment of OH, especially in higher-aged trauma patients.

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