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Obtaining serial hemoglobin (Hb) levels after injury to identify occult hemorrhage is a common practice at many U.S. hospitals. Most of the available literature is retrospective and limited to the documentation of the initial Hb or hematocrit. The value of serial Hb level in initial trauma evaluation remains controversial. The aim of this study was to examine the use of obtaining serial Hb values during the initial trauma evaluation in predicting the need for operative intervention. Our hypothesis was that initial and serial Hb values were not predictive of intervention.
After obtaining Institutional Review Board ap- proval, the study was conducted at an American College of Surgeons (ACS) -verified Level 1 trauma center over a 6-month period (July to December 2008). The study population consisted of all adult (older than 16 years) trauma admissions. Data were collected prospectively.
Data collected included demographics, injury mech- anism (blunt vs penetrating), vital signs on admission, trauma severity indices, Hb values (point-of-care test, Hem°Cue Hemoglobin Test System Hb; 201 + model, Lake Forest, CA), and emergency department (ED) fluids. The primary outcome measure was the need for operative intervention for hemostasis. To evaluate the relevance of obtaining serial Hb values during the initial trauma evaluation, patients with two Hb samples constituted the study population. This population was then divided into two groups: patients ultimately re- quiring operative intervention (intervention group) and patients managed nonoperatively (no-intervention group). To correct for selection bias, patients with one Hb sample were compared with patients with two samples.
Demographic data, vital signs, injury severity in- dices, mean ED fluids, mean Hb change (DHb) per 5 minutes, Hb drop 3 units or greater, and Hb variation over 30 minutes were compared between patients who required intervention for hemostasis...