The catecholamine response to multisystem trauma
P. D. Woolf, J. V. McDonald, D. V. Feliciano, M. M. Kelly, D. Nichols and C. Cox
Departments of Medicine, University of Rochester School of Medicine, NY.
We studied the catecholamine response in two groups of patients with
multisystem injuries according to the presence (group 1, N = 124) or
absence (group 2, N = 82) of head injury. Markers of injury severity
included the injury Severity Score, the Glasgow Coma Scale, the need for
intubation, admission hypotension, the amount of blood products and fluid
expanders administered during the first 24 hours, and patient outcome. In
group 1, higher norepinephrine levels always and epinephrine concentrations
usually were associated with worsening indexes of injury severity. The best
correlations were between the Injury Severity Score and the Glasgow Coma
Scale and norepinephrine concentrations. In group 2, despite elevated
catecholamine levels, such associations were seldom present. Thus,
circulating catecholamine levels, especially norepinephrine levels,
significantly correlated with the severity of injury in patients who had
suffered multisystem injury, but only if the injury included the brain.
