Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort
Abstract Background To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal...
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2025-01-01
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| Series: | World Journal of Emergency Surgery |
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| Online Access: | https://doi.org/10.1186/s13017-024-00572-5 |
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| author | Charles Dupuy Thibault Martinez Olivier Duranteau Tobias Gauss Natacha Kapandji Jean Pasqueron Mathilde Holleville Georges Abi Abdallah Anatole Harrois Véronique Ramonda Delphine Huet-Garrigue Théophane Doublet Marc Leone Vincent Legros Julien Pottecher Gérard Audibert Ingrid Millot Benjamin Popoff Benjamin Cohen Fanny Vardon-Bounes Mathieu Willig Pierre Gosset Emilie Angles Nouchan Mellati Nicolas Higel Mathieu Boutonnet Pierre Pasquier and the TraumaBase Group® |
| author_facet | Charles Dupuy Thibault Martinez Olivier Duranteau Tobias Gauss Natacha Kapandji Jean Pasqueron Mathilde Holleville Georges Abi Abdallah Anatole Harrois Véronique Ramonda Delphine Huet-Garrigue Théophane Doublet Marc Leone Vincent Legros Julien Pottecher Gérard Audibert Ingrid Millot Benjamin Popoff Benjamin Cohen Fanny Vardon-Bounes Mathieu Willig Pierre Gosset Emilie Angles Nouchan Mellati Nicolas Higel Mathieu Boutonnet Pierre Pasquier and the TraumaBase Group® |
| author_sort | Charles Dupuy |
| collection | DOAJ |
| description | Abstract Background To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion. Methods We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. Results A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively. Conclusions This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality. |
| format | Article |
| id | doaj-art-75f8816f8eda48bca9298201eb5d4832 |
| institution | Kabale University |
| issn | 1749-7922 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | World Journal of Emergency Surgery |
| spelling | doaj-art-75f8816f8eda48bca9298201eb5d48322025-01-12T12:12:35ZengBMCWorld Journal of Emergency Surgery1749-79222025-01-0120111010.1186/s13017-024-00572-5Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohortCharles Dupuy0Thibault Martinez1Olivier Duranteau2Tobias Gauss3Natacha Kapandji4Jean Pasqueron5Mathilde Holleville6Georges Abi Abdallah7Anatole Harrois8Véronique Ramonda9Delphine Huet-Garrigue10Théophane Doublet11Marc Leone12Vincent Legros13Julien Pottecher14Gérard Audibert15Ingrid Millot16Benjamin Popoff17Benjamin Cohen18Fanny Vardon-Bounes19Mathieu Willig20Pierre Gosset21Emilie Angles22Nouchan Mellati23Nicolas Higel24Mathieu Boutonnet25Pierre Pasquier26and the TraumaBase Group®Faculty of Medicine, Université Paris CitéFederation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training HospitalFederation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training HospitalDivision Anesthesia and Critical Care, Grenoble Alpes University HospitalDepartment of Anesthesiology and Critical Care, AP-HP, Pitié-Salpêtrière HospitalDepartment of Anesthesiology and Critical Care, AP-HP, Henri Mondor HospitalDepartment of Anesthesiology and Critical Care, Beaujon Hospital, DMU Parabol, AP-HP NordDepartment of Anesthesiology and Critical Care, AP-HP, Georges Pompidou European HospitalDepartment of Anesthesia and Critical Care, AP-HP, Bicêtre Hospital, Paris-Saclay University, DMU 12Department of Anesthesiology and Critical Care, Toulouse University HospitalDepartment of Anesthesiology and Intensive Care Unit, CHU de LilleDepartment of Anesthesiology and Intensive Care Medicine, Caen University Hospital, Normandie Univ, UNICAENDepartment of Anesthesiology and Intensive Care Unit, Nord Hospital, Assistance Publique Hôpitaux Universitaires De Marseille, Aix Marseille UniversityDepartment of Anesthesiology and Critical Care, Hôpital Maison Blanche, University HospitalDepartment of Anesthesiology and Intensive Care, Hautepierre Hospital, Strasbourg University HospitalsDepartment of Anesthesiology and Intensive Care, Nancy University HospitalIntensive Care Unit, Sainte Anne Military Teaching HospitalDepartment of Anesthesiology, Critical Care and Perioperative Medicine, CHU RouenDepartment of Anesthesiology and Intensive Care, Tours University HospitalDepartment of Anesthesiology and Critical Care, Rangueil Toulouse University HospitalDepartment of Anesthesiology and Intensive Care, Dijon University HospitalDepartment of Anesthesiology and Intensive Care, Amiens-Sud University HospitalDepartment of Anesthesiology and Intensive Care, Bordeaux University HospitalDepartment of Anesthesiology and Intensive Care, Metz HospitalDepartment of Anesthesiology and Intensive Care, Cayenne HospitalFederation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training HospitalFederation of Anesthesiology, Intensive Care Unit, Burns and Operating Theater, Percy Military Training HospitalAbstract Background To reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion. Methods We performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011–2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L. Results A total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26–57; median injury severity score: 27, IQR: 17–41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer’s V values of 0.29 and 0.28, respectively. Conclusions This study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.https://doi.org/10.1186/s13017-024-00572-5CalciumCoagulopathyTraumaHemorrhageLethal triadLethal diamond |
| spellingShingle | Charles Dupuy Thibault Martinez Olivier Duranteau Tobias Gauss Natacha Kapandji Jean Pasqueron Mathilde Holleville Georges Abi Abdallah Anatole Harrois Véronique Ramonda Delphine Huet-Garrigue Théophane Doublet Marc Leone Vincent Legros Julien Pottecher Gérard Audibert Ingrid Millot Benjamin Popoff Benjamin Cohen Fanny Vardon-Bounes Mathieu Willig Pierre Gosset Emilie Angles Nouchan Mellati Nicolas Higel Mathieu Boutonnet Pierre Pasquier and the TraumaBase Group® Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort World Journal of Emergency Surgery Calcium Coagulopathy Trauma Hemorrhage Lethal triad Lethal diamond |
| title | Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort |
| title_full | Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort |
| title_fullStr | Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort |
| title_full_unstemmed | Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort |
| title_short | Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort |
| title_sort | comparison of the lethal triad and the lethal diamond in severe trauma patients a multicenter cohort |
| topic | Calcium Coagulopathy Trauma Hemorrhage Lethal triad Lethal diamond |
| url | https://doi.org/10.1186/s13017-024-00572-5 |
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