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Author Williams, Deborah J. ♦ Guirgis, Faheem W. ♦ Morrissey, Thomas K. ♦ Wilkerson, Jennifer ♦ Wears, Robert L. ♦ Kalynych, Colleen ♦ Kerwin, Andrew J. ♦ Godwin, Steven A.
Source World Health Organization (WHO)-Global Index Medicus
Content type Text
Publisher Elsevier
File Format HTM / HTML
Language English
Difficulty Level Medium
Subject Domain (in DDC) Technology ♦ Medicine & health
Abstract OBJECTIVE: To determine if early measurement of end-tidal carbon dioxide (ETCO ) in nonintubated patients triaged to a level 1 trauma center has utility in ruling out severe injury. METHODS: We performed a prospective cohort study of adult patients triaged to our urban, academic, level 1 trauma center. Included patients had ETCO measured within 30 minutes of arrival. Chart review was performed on enrolled patients to identify severe injury defined by: admission to an intensive care unit, need for an invasive procedure, blood product transfusion, acute blood loss anemia, and acute clinically significant finding on computed tomographic scan. RESULTS: Of 170 patients enrolled, 115 met the outcome of no severe injury. Mean ETCO for patients without and with severe injury was 33.1 mm Hg (SD, 5.8) and 30.3 mm Hg (SD, 6.7), respectively. This difference reached statistical significance (P=.05), but did not demonstrate added clinical utility when combined with Glasgow Coma Scale, systolic blood pressure, and age in predicting the primary outcome (area under curve, 0.70 with ETCO vs area under curve, 0.68 without ETCO , P=.5). Patients with ETCO ≤30 mm Hg were found to be older, more likely to require intensive care unit admission or emergency operative intervention, develop acute blood loss anemia, and have an acute finding on computed tomography than patients with a higher ETCO . CONCLUSION: End-tidal carbon dioxide cannot be used to rule out severe injury in patients meeting criteria for trauma center care. The ETCO ≤30 mm Hg may be associated with increased risk of traumatic severe injury.
Description Author Affiliation: Williams DJ ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209. Electronic address: deborah.j.williams@jax.ufl.edu.); Guirgis FW ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.); Morrissey TK ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.); Wilkerson J ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.); Wears RL ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.); Kalynych C ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.); Kerwin AJ ( Department of Surgery, Division of Acute Care Surgery, University of Florida, Jacksonville, Jacksonville, FL 32209.); Godwin SA ( Department of Emergency Medicine, University of Florida, Jacksonville, Jacksonville, FL 32209.)
ISSN 07356757
Educational Role Student ♦ Teacher
Age Range above 22 year
Educational Use Reading ♦ Research ♦ Self Learning
Interactivity Type Expositive
Education Level UG and PG
Learning Resource Type Article
Publisher Date 2016-11-01
Publisher Place United States
e-ISSN 15328171
Journal The American Journal of Emergency Medicine
Volume Number 34
Issue Number 11


Source: WHO-Global Index Medicus