Shock horror! How accurate is the PHTLS classification of hypovolaemic shock on scene?

Pre-hospital assessment and management of major trauma is challenging, and this research highlights some of the complexities confronting ambulance staff when encountering these events. The purpose of this retrospective study was to validate the pre-hospital trauma life support (PHTLS) classification of hypovolaemic shock, derived from the advanced trauma life support (ATLS) guidelines.

Data on 46 689 adult patients (2002 until 2011) were extracted from a German trauma register and were classified into reference ranges reflecting the PHTLS classification of hypovolaemic shock: heart rate (HR), systolic blood pressure (SBP) and Glasgow coma scale (GCS).

The first stage of analysis involved grouping patients by a combination of all three of these factors as suggested by PHTLS; in the next stage patients were classified by one parameter (HR, SBP or GCS) only and alterations in the remaining two parameters were assessed.

Overall, the results show substantial deficits in the PHTLS classification of hypovolaemic shock when risk-stratifying trauma patients.