A Scoping Review of Hyperacute Physiology and its Predictive Value for Bleeding in the Immediate Post Injury Phase

Abstract Objective: This scoping review aims to examine and map the evidence describing the physiology of the immediate post injury period and its ability to predict bleeding in a pre-hospital trauma setting. This will identify gaps in evidence and inform future research. Introduction: Blood transfusion is an important part of trauma management in order to resuscitate a bleeding patient. However, identifying patients who are bleeding is not always straightforward. Existing guidelines rely on crude vital signs such as blood pressure and heart rate which have been shown to be poor predictors for identifying bleeding. Other parameters like lactate, base deficit, Glasgow Coma Score, and end tidal CO2 have shown predictive power for bleeding in a hyperacute trauma setting and will be examined in this review. Inclusion criteria: Sources examining acute physiology in the context of trauma or traumatic injury among adults, including both prehospital and acute care, will be included in the review. Animal studies, studies published prior to 2016 and non-English language sources will be excluded. Methods: A search strategy for MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews was developed from a preliminary search conducted on MEDLINE. Titles and abstracts will be screened against the inclusion/exclusion criteria, and the full texts will be extracted for citations meeting the criteria. A further screening will be undertaken, and successful texts will undergo data extraction using Covidence software. This data will be collated using Excel and presented in tabular and graphical form as appropriate. Key words: bleeding; physiology; prehospital; trauma