A low serum ionized calcium on admission of a trauma patient is associated with massive transfusion and increased mortality.
Pathogenesis: low serum ionized calcium is associated with severe trauma and with traumatic coagulopathy (initial INR > 1.5)
Patient selection: major trauma
Specimen collection: immediately upon admission
Criteria of Magnotti et al for low ionized calcium: < 1 mmol/L
Criteria of Vasudeva et al for low ionized calcium: < 1.11 mmol/L
Data of Magnotti
Ionized Calcium < 1.0
Ionized Calcium >= 1.0
mortality
15.5%
8.7%
multiple transfusions
17.1%
7.1%
massive transfusion
8.2%
2.2%
Odds ratio for massive transfusion (Magnotti et al): 2.3
The differential diagnosis of low serum ionized calcium includes is massive transfusion, so the timing of specimen collection relative to transfusion is important.
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