Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

Fang-Yu Hsu, Shih-Hsuan Mao, Andy Deng-Chi Chuang, Yon-Cheong Wong and Chih-Hao Chen
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Fang-Yu Hsu: Craniofacial Research Center and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Shih-Hsuan Mao: Craniofacial Research Center and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Andy Deng-Chi Chuang: Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Keelung, Keelung 204, Taiwan
Yon-Cheong Wong: Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
Chih-Hao Chen: Craniofacial Research Center and Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan

IJERPH, 2021, vol. 18, issue 21, 1-12

Abstract: The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group ( p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

Keywords: traumatic oronasal bleeding; transarterial embolization; craniofacial trauma; shock index; systolic blood pressure; heart rate (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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