Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study
Abstract Background Derangements in ionized calcium are common following trauma, with prior research describing an association between hypocalcemia and adverse outcomes such as mortality, coagulopathy severity, and transfusion requirement. The present study evaluates clinical characteristics of pati...
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2025-07-01
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| Series: | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
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| Online Access: | https://doi.org/10.1186/s13049-025-01441-z |
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| author | Jessica B. Oudakker Christiaan A. Rees George Oosthuizen Elmin Steyn Shaheem de Vries Janette Verster Craig Wylie Mohammed Mayet Lesley Hodsdon Karlien Doubell Leigh Wagner L’Oreal Snyders Denise Lourens Julia M. Dixon Jessica L. Wild Mengli Xiao Lani Finck Steven G. Schauer Hendrick J. Lategan Nee-Kofi Mould-Millman |
| author_facet | Jessica B. Oudakker Christiaan A. Rees George Oosthuizen Elmin Steyn Shaheem de Vries Janette Verster Craig Wylie Mohammed Mayet Lesley Hodsdon Karlien Doubell Leigh Wagner L’Oreal Snyders Denise Lourens Julia M. Dixon Jessica L. Wild Mengli Xiao Lani Finck Steven G. Schauer Hendrick J. Lategan Nee-Kofi Mould-Millman |
| author_sort | Jessica B. Oudakker |
| collection | DOAJ |
| description | Abstract Background Derangements in ionized calcium are common following trauma, with prior research describing an association between hypocalcemia and adverse outcomes such as mortality, coagulopathy severity, and transfusion requirement. The present study evaluates clinical characteristics of patients presenting to emergency care with ionized calcium derangements following severe trauma in a low-resource practice setting. Methods Patients presenting to emergency care throughout the Western Cape of South Africa following severe traumatic injury (excluding patients with severe traumatic brain injury) for whom an ionized calcium level was measured are included. Patients were stratified according to initial ionized calcium, and characteristics of the different strata (demographics, injury characteristics, and initial serum biomarkers) were compared. Linear and quadratic regression was used to evaluate the relationship between initial ionized calcium and selected laboratory markers such as hemoglobin, lactate, venous pH, and platelets. Results 1989 subjects were included. The median initial ionized calcium was 1.14 mmol/L (IQR: 1.09–1.19 mmol/L). 51% of patients were hypocalcemic (< 1.15 mmol/L), and 1.0% hypercalcemic (> 1.29 mmol/L) on presentation. Differences were observed between ionized calcium strata with respect to age (p < 0.01), injury body region (p = 0.02), maximum abbreviated injury scale (AIS) score (p = 0.03), and shock index (p = 0.05). There was a statistically significant relationship between initial ionized calcium and both platelets (p < 0.01) and hemoglobin (p = 0.03) when treating ionized calcium as a quadratic (U-shaped) variable. Conclusions Derangements in ionized calcium following acute trauma are associated with injury severity (as defined by maximum AIS score) and injury body region, as well as a subset of other laboratory values, including platelet count and hemoglobin. It is notable that the relationship between these variables was parabolic, suggesting that both extremes of ionized calcium derangements are associated with derangements in other serum markers. Trial registration Not applicable to this study. |
| format | Article |
| id | doaj-art-41c815dda4314b788fed28a38a92fcc5 |
| institution | Kabale University |
| issn | 1757-7241 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine |
| spelling | doaj-art-41c815dda4314b788fed28a38a92fcc52025-08-20T03:46:21ZengBMCScandinavian Journal of Trauma, Resuscitation and Emergency Medicine1757-72412025-07-0133111110.1186/s13049-025-01441-zCorrelates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) studyJessica B. Oudakker0Christiaan A. Rees1George Oosthuizen2Elmin Steyn3Shaheem de Vries4Janette Verster5Craig Wylie6Mohammed Mayet7Lesley Hodsdon8Karlien Doubell9Leigh Wagner10L’Oreal Snyders11Denise Lourens12Julia M. Dixon13Jessica L. Wild14Mengli Xiao15Lani Finck16Steven G. Schauer17Hendrick J. Lategan18Nee-Kofi Mould-Millman19Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Anschutz Medical CampusDivision of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Anschutz Medical CampusDivision of Surgery, Department of Surgical Sciences, Stellenbosch UniversityDivision of Surgery, Department of Surgical Sciences, Stellenbosch UniversityCollaborative for Emergency Care in AfricaDivision of Forensic Medicine, Department of Pathology, Stellenbosch UniversityWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessWestern Cape Government Health and WellnessDepartment of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical CampusDepartment of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical CampusDepartment of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Anschutz Medical CampusDepartment of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical CampusCenter for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Anschutz Medical CampusDivision of Surgery, Department of Surgical Sciences, Stellenbosch UniversityDepartment of Emergency Medicine, University of Colorado School of Medicine, Anschutz Medical CampusAbstract Background Derangements in ionized calcium are common following trauma, with prior research describing an association between hypocalcemia and adverse outcomes such as mortality, coagulopathy severity, and transfusion requirement. The present study evaluates clinical characteristics of patients presenting to emergency care with ionized calcium derangements following severe trauma in a low-resource practice setting. Methods Patients presenting to emergency care throughout the Western Cape of South Africa following severe traumatic injury (excluding patients with severe traumatic brain injury) for whom an ionized calcium level was measured are included. Patients were stratified according to initial ionized calcium, and characteristics of the different strata (demographics, injury characteristics, and initial serum biomarkers) were compared. Linear and quadratic regression was used to evaluate the relationship between initial ionized calcium and selected laboratory markers such as hemoglobin, lactate, venous pH, and platelets. Results 1989 subjects were included. The median initial ionized calcium was 1.14 mmol/L (IQR: 1.09–1.19 mmol/L). 51% of patients were hypocalcemic (< 1.15 mmol/L), and 1.0% hypercalcemic (> 1.29 mmol/L) on presentation. Differences were observed between ionized calcium strata with respect to age (p < 0.01), injury body region (p = 0.02), maximum abbreviated injury scale (AIS) score (p = 0.03), and shock index (p = 0.05). There was a statistically significant relationship between initial ionized calcium and both platelets (p < 0.01) and hemoglobin (p = 0.03) when treating ionized calcium as a quadratic (U-shaped) variable. Conclusions Derangements in ionized calcium following acute trauma are associated with injury severity (as defined by maximum AIS score) and injury body region, as well as a subset of other laboratory values, including platelet count and hemoglobin. It is notable that the relationship between these variables was parabolic, suggesting that both extremes of ionized calcium derangements are associated with derangements in other serum markers. Trial registration Not applicable to this study.https://doi.org/10.1186/s13049-025-01441-zHypocalcemiaTraumaEpidemiologyGlobal healthHypercalcemia |
| spellingShingle | Jessica B. Oudakker Christiaan A. Rees George Oosthuizen Elmin Steyn Shaheem de Vries Janette Verster Craig Wylie Mohammed Mayet Lesley Hodsdon Karlien Doubell Leigh Wagner L’Oreal Snyders Denise Lourens Julia M. Dixon Jessica L. Wild Mengli Xiao Lani Finck Steven G. Schauer Hendrick J. Lategan Nee-Kofi Mould-Millman Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine Hypocalcemia Trauma Epidemiology Global health Hypercalcemia |
| title | Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study |
| title_full | Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study |
| title_fullStr | Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study |
| title_full_unstemmed | Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study |
| title_short | Correlates of incident hypocalcemia amongst trauma patients in the Western Cape of South Africa: a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study |
| title_sort | correlates of incident hypocalcemia amongst trauma patients in the western cape of south africa a secondary analysis of the epidemiology and outcomes of prolonged trauma care epic study |
| topic | Hypocalcemia Trauma Epidemiology Global health Hypercalcemia |
| url | https://doi.org/10.1186/s13049-025-01441-z |
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