{"title":"Prevalence and outcomes of hypocalcemia on ED arrival in traumatic patients before blood transfusions: a systematic review and meta-analysis.","authors":"Wuttipong Srichuachom, Sarunsorn Krintratun, Boriboon Chenthanakij, Wachira Wongtanasarasin","doi":"10.1186/s13049-025-01361-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Hypocalcemia represents a critical physiological disturbance in trauma-related hemorrhagic shock patients. Nonetheless, the prevalence and effects of hypocalcemia remain uncertain. This study aims to explore the prevalence of hypocalcemia before blood transfusions and its related mortality in adult patients with major traumatic injuries.</p><p><strong>Method: </strong>We conducted a systematic search through databases, including PubMed, EMBASE, Scopus, and Web of Science, from their inception until June 30, 2024. Patients with major traumatic injuries whose serum calcium was measured upon arrival at the emergency department (ED) were included. We excluded those with prior blood transfusions, pre-clinical studies, review articles, and studies without a control group. Meta-analysis using a random-effect model was performed. Heterogeneity was evaluated using Cochrane Q and I² statistics. The study's risk of bias was assessed using the Joanna Briggs Institute's critical appraisal checklist. Publication bias was assessed using Egger's test and contour funnel plot visualization.</p><p><strong>Results: </strong>Of the total, 1,984 abstracts were screened, leading to 15 studies in this review and meta-analysis. The overall prevalence of hypocalcemia upon ED arrival was 56% (95% CI 37%-74%), with high heterogeneity (I<sup>2</sup> 99.8%) observed. Hypocalcemia patients also had higher mortality rates than normocalcemia patients (OR 2.44, 95% CI 1.76-3.40).</p><p><strong>Conclusion: </strong>Hypocalcemia on ED arrival is common among adult trauma patients, who also exhibit a notably high mortality rate within this demographic. We recommend the monitoring of ionized calcium levels in traumatic adult patients. Furthermore, systematically designed studies examining the optimal thresholds, treatment protocols, and outcomes should be prioritized as the focal point of research.</p><p><strong>Trial registration: </strong>CRD42024549054 ( http://www.crd.york.ac.uk/PROSPERO ).</p>","PeriodicalId":49292,"journal":{"name":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","volume":"33 1","pages":"43"},"PeriodicalIF":3.0000,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11916158/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Scandinavian Journal of Trauma Resuscitation & Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13049-025-01361-y","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Hypocalcemia represents a critical physiological disturbance in trauma-related hemorrhagic shock patients. Nonetheless, the prevalence and effects of hypocalcemia remain uncertain. This study aims to explore the prevalence of hypocalcemia before blood transfusions and its related mortality in adult patients with major traumatic injuries.
Method: We conducted a systematic search through databases, including PubMed, EMBASE, Scopus, and Web of Science, from their inception until June 30, 2024. Patients with major traumatic injuries whose serum calcium was measured upon arrival at the emergency department (ED) were included. We excluded those with prior blood transfusions, pre-clinical studies, review articles, and studies without a control group. Meta-analysis using a random-effect model was performed. Heterogeneity was evaluated using Cochrane Q and I² statistics. The study's risk of bias was assessed using the Joanna Briggs Institute's critical appraisal checklist. Publication bias was assessed using Egger's test and contour funnel plot visualization.
Results: Of the total, 1,984 abstracts were screened, leading to 15 studies in this review and meta-analysis. The overall prevalence of hypocalcemia upon ED arrival was 56% (95% CI 37%-74%), with high heterogeneity (I2 99.8%) observed. Hypocalcemia patients also had higher mortality rates than normocalcemia patients (OR 2.44, 95% CI 1.76-3.40).
Conclusion: Hypocalcemia on ED arrival is common among adult trauma patients, who also exhibit a notably high mortality rate within this demographic. We recommend the monitoring of ionized calcium levels in traumatic adult patients. Furthermore, systematically designed studies examining the optimal thresholds, treatment protocols, and outcomes should be prioritized as the focal point of research.
背景：低钙血症是创伤性失血性休克患者的一种重要生理障碍。尽管如此，低钙血症的患病率和影响仍然不确定。本研究旨在探讨成人重大创伤患者输血前低钙血症的患病率及其相关死亡率。方法：对PubMed、EMBASE、Scopus、Web of Science等数据库进行系统检索，检索时间从其成立到2024年6月30日。本研究纳入了在急诊科（ED）到达时测定血清钙的严重创伤患者。我们排除了那些有输血史、临床前研究、综述文章和没有对照组的研究。采用随机效应模型进行meta分析。采用Cochrane Q和I²统计量评估异质性。这项研究的偏倚风险是用乔安娜布里格斯研究所的批判性评估清单来评估的。采用Egger检验和轮廓漏斗图可视化评估发表偏倚。结果：共筛选了1984篇摘要，在本综述和荟萃分析中纳入了15项研究。ED到达时低钙血症的总体患病率为56% (95% CI 37%-74%)，观察到高度异质性（I2 99.8%）。低钙血症患者的死亡率也高于正常钙血症患者（OR 2.44, 95% CI 1.76-3.40）。结论：ED到达时的低钙血症在成人创伤患者中很常见，在这一人群中也表现出明显的高死亡率。我们建议在创伤性成人患者中监测电离钙水平。此外，研究最佳阈值、治疗方案和结果的系统设计研究应优先作为研究的重点。试验注册：CRD42024549054 （http://www.crd.york.ac.uk/PROSPERO）。
期刊介绍：
The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.
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