Association of capillary refill time with mortality in adult trauma patients: a secondary analysis of the CRASH-2 randomised controlled trial data

Association of capillary refill time with mortality in adult trauma patients: a secondary analysis of the CRASH-2 randomised controlled trial data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of capillary refill time with mortality in adult trauma patients: a secondary analysis of the CRASH-2 randomised controlled trial data Sabrina Jegerlehner, Tim Harris, Martin Mueller, Ben Bloom This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6302516/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 May, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted 12 You are reading this latest preprint version Abstract Background : Trauma-related injuries account for up to 4.4 million deaths annually worldwide. Failure to identify haemorrhage in trauma patients increases mortality. This study examines the association of capillary refill time (CRT) and mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP). Methods : This retrospective observational study analysed data from the CRASH-2 trial, conducted in 274 hospitals across 40 countries and 5 continents between May 2005 and January 2010. A total of 19,054 out of 20,207 adult trauma patients with recorded CRT and complete dataset were included. CRT was categorized as ≤ 2, 3-4, and ≥ 5 seconds. The primary outcome was 28-day mortality, while secondary outcomes included need for transfusion, surgical intervention and thromboembolic events. Univariable and multivariable logistic regression analysis were conducted, incorporating random effects for continent/cluster. Receiver operating characteristic curves were used to assess the discriminatory ability of CRT measurement Results : Among the patients, 6,756 (35.5%) had a CRT ≤2 seconds, 9,142 (48%) had a CRT of 3–4 seconds, and 3,156 (16.6%) had a CRT ≥5 seconds. Compared to the reference category (CRT ≤2 seconds), the odds of death were significantly higher in patients with CRT of 3–4 seconds (OR 1.7, 95% CI 1.6–1.9) and CRT ≥5 seconds (OR 3.2, 95% CI 2.8–3.5). Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention, and thromboembolic events. However, CRT demonstrated poor test accuracy for mortality prediction, with area under the curve (AUC) values around 0.6. Conclusion : CRT is associated with increased mortality and adverse outcomes in trauma patients. However, due to its low predictive accuracy, CRT alone is insufficient as a screening tool in pre-hospital settings. Nevertheless, it may provide additional value in patients with normal blood pressure and heart rate. In bleeding trauma patients, an increasing CRT is linked to higher mortality risk, with a CRT ≥5 seconds being particularly predictive of worse outcomes, even in patients with stable vital signs. emergency medicine capillary refill time trauma mortality shock pre-hospital Figures Figure 1 Figure 2 BACKGROUND Injuries, whether they result from accidents or acts of violence, claim the lives of 4.4 million individuals worldwide annually, accounting for nearly 8% of the total global mortality rate. 1 Haemorrhage accounts for about one third of in-hospital trauma deaths, 2 and contributes to other causes of death such as head injury and organ dysfunction. 3 Failure to identify patients with haemorrhage and institute early treatment increases mortality. 4 However, estimation of the extent of haemorrhage is difficult, especially in compensated shock when haemodynamic parameters are still within normal range. CRT is defined as the time taken for a skin capillary bed to regain its colour after sufficient pressure has been applied to cause blanching. 5 Vasoconstriction leading to reduced distal capillary bed perfusion is considered an early compensatory mechanism to shock. Delayed reperfusion is a marker of circulatory impairment. CRT may reflect alterations in the microcirculation even when systemic haemodynamics remain normal. 6 Therefore, CRT is advocated as a simple and rapid assessment method for (compensated) shock and is commonly used both in-hospital and pre-hospital. 7 CRT is widely used in the assessment of ill neonates and children, e.g. for hypovolemia and sepsis a CRT of ≤ 2 seconds is a treatment target for resuscitation in sepsis, is part of the assessment of circulation in the European Resuscitation Council algorithm for pre-hospital care, and is one of five components of the Trauma Score. 6–11 Its use is advocated by the adult and paediatric life support algorithms. However, there are few outcome data to support the use of CRT in adult trauma patients. The association of CRT with mortality in adult trauma patients was investigated, using data from the CRASH-2 trial. The primary objective was to investigate the association of CRT with 28-day mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP) to assess whether the use of CRT should be advocated. METHODS Study design This was a secondary analysis of the CRASH-2 trial data. 12 CRASH-2 has been previously described. 13 Briefly, CRASH-2 was a randomised controlled trial of tranexamic acid versus placebo in adult patients with trauma and significant haemorrhage. It was conducted in 274 hospitals in 40 countries from May 2005 to January 2010 and included 20,211 adult trauma patients. 12 For this study, all 20,207 patients included in CRASH-2 were eligible and those with missing or erroneous data were excluded. The primary outcome was 28-day mortality, and the secondary outcomes were need for transfusion, surgical intervention and thromboembolic events. Data collection CRT was defined as the time (in seconds) taken for a skin capillary bed to regain its colour after sufficient pressure has been applied to cause blanching, and was measured centrally on the middle of the chest. In the CRASH-2 trial, CRT was collected in seconds. For this study, CRT was categorised as ≤ 2, 3-4, and ≥ 5 seconds based on pathological definitions of normal CRT. 11, 14-17 In this trauma patient population, normal BP was defined as systolic blood pressure (SBP) ³ 100mmHgm and normal HR was defined as £ 100/minute. Data analysis Statistical analysis was conducted using STATA 18.0 (MP, StataCorp, College Station, TX, USA). Statistical significance was defined as p value < 0.05. For the continuous variable we estimated means and standard deviations (SD) or median and interquartile range (IQR) for normally and non-normally distributed data respectively based on Shapiro-Wilk testing. Categorical data were reported as proportions Differences in continuous data were analysed using the t test (normal distribution) or Wilcoxon rank sum test (non-normal distribution); categorial data were compared using the chi 2 test. For the primary outcome and all other binary outcomes, odds ratios (ORs), 95% confidence intervals (CIs) and two-sided p values for statistical significance were calculated. Univariable and multivariable logistic regression analysis was performed to assess the association of CRT with mortality and all other secondary outcomes. Because patients from different countries represent a nested (clustered) dataset, random effect modelling for countries was used to account for the inter-country variance (clustering). Receiver operating characteristic (ROC) curves were used to assess the discrimination (C statistic, area-under-the-curve [AUC]) of the logistic regression model. RESULTS Overall, 20,207 patients were included in the original dataset, of whom 611 (4%) did not have a CRT recorded and 543 (3%) had missing or erroneous values and were therefore excluded. The final dataset analysed included 19,054 patients ( Figure 1 ). Baseline characteristics of the study population are shown in Table 1 . 16,000 (84%) patients were male, the median age was 31 (IQR 24-43) years, 10,562 (55%) suffered from blunt trauma and 6,179 (32%) from penetrating trauma. 6,756 (36%) patients had a CRT ≤ 2 seconds, 9,142 (48%) from 3-4 seconds, and 3,356 (17%) ≥ 5 seconds. Over the study period of 28 days, 2,802 (15%) patients died, of which 1,154 (6%) died from a head injury, 902 (5%) died from haemorrhage, and 80 (< 1%) patients died from a thromboembolic event In multivariable logistic regression analysis, the OR for death was 1.76 (95% CI 1.58-1.95) and 23.21 (95% CI 2.83-3.65) in the CRT categories of 3-4 seconds and ≥ 5 seconds respectively compared to the reference category of ≤ 2 seconds ( Table 2 ). In the subgroup of patients with normal HR and BP, i.e., “no shock”, there was an OR for death of 1.78 (95% CI 1.58-2.00) and 2.69 (95% CI 2.30-3.13) in the CRT categories of 3-4 seconds and ≥ 5 seconds respectively ( Table 2 and Figure 2 ). Secondary outcomes shown in Table 2 . An increasing CRT was associated with increased risk of transfusion, surgical intervention, and occurrence of thromboembolic events with OR between 1.25-1.57 for CRT of 3-4 seconds and OR of 1.57-2.45 for CRT of ≥ 5 seconds. DISCUSSION Comparisons with other studies In this study using data from 20,000 trauma patients, increasing CRT was associated with an increased risk of death overall and in subgroups of patients with normal HR and BP. In patients with CRT ≥ 5 seconds there was greater than three-fold risk, and a more than twofold risk of other adverse outcomes such as need for transfusion and occurrence of thromboembolic events. Jouffrouy et al. 15 examined the association of CRT with mortality in patients with septic shock. They found a significant association of CRT values > 4 seconds with 28 day mortality (OR 1.5, 95% CI 1.0-2.4). However, in contrast to our study, this is a retrospective single centre study, and it included patients in septic shock with an overall mortality of 36% - higher than the mortality of the trauma patients in the CRASH-2 trial. Mrgan et al. 19 performed a prospective cohort study with adult acute medical patients. They found an increasing one-day mortality with abnormal CRT; and a high negative predictive value for death with normal CRT. However, those were again medical patients, and with a median age of 66 years they were substantially older than the patients in CRASH-2. Additionally, Mrgan et al. concluded that other vital signs such as HR had a stronger association with death and were therefore better predictors for mortality than CRT. 19 This is contrary to our results, where even patients with normal HR and BP had an increased risk for death when CRT was prolonged. The test accuracy of CRT assessment with ROC AUC values of about 0.7 is acceptable. These results are in contrast with other studies. In their prospective cohort study, Londono et al. 21 examined the association of clinical hypoperfusion parameters such as CRT with lactate levels and mortality. They found that none of the clinical parameters had an adequate discriminatory capacity to detect hyperlactatemia (AUC < 0.62) or to predict mortality; and that only hyperlactatemia was associated with mortality. 21 The limitations of CRT as a clinical test are well known with CRT measurements varying with age, gender, temperature, site of assessment and light conditions. 17, 23 Strengths and limitations This study is the first to investigate the value of CRT to predict mortality in adult trauma patients using comprehensive and exhaustive data from the multicenter randomised controlled CRASH-2 trial. Adjustment for external and ambient confounders was not possible in this study. However, central CRT was used, which was standardised across all CRASH-2 trial sites, and which is less dependent on temperature. Furthermore, the CRASH-2 trial included patients who were judged to have or to be at risk of on-going significant haemorrhage. These inclusion criteria are purely clinical and could represent a source of selection bias. However, the large number of trial participants in different healthcare settings, and thus heterogeneity of the study population, still guarantees generalisability of the results. The CRASH-2 study population is predominantly young and male, and these results may not be applicable in other populations. This study was not designed prospectively to determine a threshold for CRT values above which mortality is increased. However, different cut-offs and definitions for abnormal CRT as previously described in the literature were investigated. There was increasing mortality with rising CRT, and therefore CRT is a continuous rather than a binary predictor for mortality. CONCLUSION In bleeding trauma patients, rising CRT is associated with increased mortality. A CRT ≥ 5 seconds is predictive for increased mortality in trauma patients, even when HR and BP are within normal range. Abbreviations AUC: area under the curve CRASH: clinical randomisation of an antifibrinolytic in significant haemorrhage CRT: capillary refill time CI: confidence Interval DCRT: digital CRT HR: heart rate IQR: interquartile range OP: operation OR: odds ratio ROC: receiver operating characteristic curves RR: relative risk SBP: systolic blood pressure SD: standard deviation TXA: tranexamic acid VTE: venous thromboembolic event Declarations Ethics approval and consent to participate The research was conducted in accordance with the Declaration of Helsinki, ensuring adherence to ethical principles for medical research involving human subjects. The CRASH-2 trial had UK Research Ethics Committee approval and was approved by the relevant ethics committees in all 274 participating hospitals. Informed consent procedures were established by local regulation and the appropriate ethics committees. The Data Monitoring and Ethics Committee (DMEC) had the responsibility for randomization. This is a secondary analysis of data from this trial, and therefore no additional ethics approval was needed. Availability of data and materials CRASH-2 data is publicly available. Consent for publication Not applicable. Competing interests All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf, and declare that they do not have any competing interests. Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Authors' contributions TH, BB and SJ conceived the study. MM analysed the data and provided statistical expertise. SJ wrote the first draft of the paper. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The authors assume full responsibility for analyses and interpretation of these data. SJ is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. References https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence - Date: 2021 Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995; 38:185-93. Kauvar DS, Lefering R, Wade CE. Impact of haemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:S3-11 Tien HC, Spencer F, Tremblay LN, et al. Preventable deaths from haemorrhage at a level I Canadian trauma centre. J Trauma 2007;62(1):142-46 Beecher HK, Simeone FA, Burnett CH, e al. The internal state of the severely wounded man on entry to the most forward hospital. Surgery. 1947:22;672-711. Pickard A, Karlen W, Ansermino JM. Capillary refill time: Is it still a useful clinical sign? Anesth Analg. 2011; 113:120-3. Harrison TR, ed. Harrison’s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 1998. Hazinski MF, Zaritsky AL, Nadkarni VM, eds. PALS Provider Manual. Dallas: American Heart Association, 2002. Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guideliens for management of severe sepsis and septic shock: 2016. Intensive Care Med 2017;43(3):304-377. Monsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council guidelines of resuscitation 2015. Section 1: executive summary. Resuscitation 2015; 95:1-80. Champion HR, Sacco WJ, Carnazzo AJ, et al. Trauma score. Crit Care Med.1981 Sep;9(9):672-6. CRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid in death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010:376(9734);23-32. The CRASH Trials Co-ordinating Centre. Protocol 05PRT/1: The CRASH-2 (Clinical Randomization of an Anti-fibrinolytic in Significant Haemorrhage) trial. The Lancet 2005. Lewin J, Maconochie I. Capillary refill time in adults. EMJ 2008;25:325-6. Jouffroy R, Saade A, Tourtier JP, et al. Skin mottling score and capillary refill time to assess mortality of septic shock since prehospital setting. Am J Emerg Med. 2019 Apr;37(4):664-671. Espinoza ED, Welsh S, Dubin A. Lack of agreement between different observers and methods in the measurement of capillary refill time in healthy volunteers: an observational study. Rev Bras Ter Intensiva. 2014;26(3):269–276. Schriger D, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988;17:932-5. DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837-845. Mrgan M, Rytter D, Brabrand N. Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study. Emerg Med J 2014;31:954–958. Nickel A, Jiang S, Napolitano N, et al. Abstract 276: Impact of Skin Color on Accuracy of Capillary Refill Time Measurement by Pulse Oximeter. Circulation. 2018;138:A276. Londono J, Nino C, Diaz J, et al. Association of clinical hypoperfusion with lactate clearance and mortality. Shock. 2018;286-292. Anderson B, Kelly AM, Kerr D, et al. Capillary refill time in adults has poor interobserver agreement. Hong Kong J Emerg Med 2008;15:71–4 Brown LH, Prasad NH, Whitley TW. Adverse lighting condition effects on the assessment of capillary refill. Am J Emerg Med 1994;12:46–7. Shavit I, Brant R, Nijssen-Jordan C, et al. A novel imaging technique to measure capillary-refill time: improving diagnostic accuracy for dehydration in young children with gastroenteritis. Pediatrics 2006;118:2402-8 Kviesis-Kipge E, Curkste E, Spigulis J, et al. Optical Studies of the Capillary Refill Kinetics in Fingertips. Doessel O, Schlegel WC, eds. World Congress on Medical Physics and Biomedical Engineering, 2009, Munich, Germany. Berlin: Springer, 2009:377-9 Tables Table 1 . Baseline characteristics of the study patients. CRT: capillary refill time, HR: heart rate, N: absolute count, OP: need for surgical intervention, RR: respiratory rate, s: seconds, SBP: systolic blood pressure, VTE: thromboembolic event. Total n=19,054 Survived n=16,252 Death n=2801 p value Age (years) 31 [24; 43] 30 [23; 42] 35 [25; 48] 80 years 89 [0.5] 49 [0.3] 40 [1.4] <0.001 Gender Male 16,000 [84.0] 13,656 [84.0] 2,344 [83.7] Female 3,054 [16.0] 2,596 [16.0] 458 [16.3] 0.620 Type of injury Blunt 10,562 [55.4] 8,794 [54.1] 1,768 [63.1] Penetrating 6,179 [32.4] 5,567 [34.3] 612 [21.8] Combined 2,313 [12.1] 1,891 [11.6] 422 [15.1] <0.001 Vital parameters SBP (mmHg) 96 [80; 110] 100 [86; 111] 90 [70; 100] <0.001 HR (per minute) 105 [90; 120] 102 [90; 118] 110 [96; 126] <0.001 RR (per minute) 22 [20; 26] 22 [20; 26] 24 [20; 30] <0.001 Shock 3,077 [16.1] 2,242 [13.8] 835 [29.8] 2-4s 9142 [48.0] 7772 [47.8] 1,370 [48.9] >4s 3156 [16.6] 2411 [14.8] 745 [26.6] <0.001 28-day mortality Survived 16,252 [85.3] 16,252 [100.0] 0 [0.0] Dead 2,802 [14.7] 0 [0.0] 2,802 [100.0] <0.001 Cause of death Bleed 902 [4.7] n.a. 902 [32.2] Head injury 1,154 [6.1] n.a. 1,154 [41.2] VTE 80 [0.4] n.a. 80 [2.9] Other 666 [3.5] n.a. 666 [23.8] <0.001 Secondary outcomes Transfusion 9,534 [50.0] 7,702 [47.4] 1,832 [65.4] <0.001 OP 9,580 [50.3] 8,139 [50.1] 1,441 [51.4] 0.188 VTE 334 [1.8] 193 [1.2] 141 [5.0] <0.001 Table 2. Multivariable logistic regression analysis: OR for 28-day mortality by CRT category against reference category (CRT ≤ 2 s). AUC: area under the curve, CI: confidence interval, CRT: capillary refill time, OR: odds ratio, s: seconds, VTE: venous thromboembolic event. CRT group OR death all 95% CI p value AUC 0-2 s 1 > 2-4 s 1.76 1.58-1.95 4 s 3.21 2.83-3.65 2-4 s 1.47 1.15-1.88 0.002 > 4 s 2.43 1.86-3.18 2-4 s 1.78 1.58-2.00 4 s 2.69 2.30-3.13 2-4 s 1.39 1.30-1.49 4 s 2.06 1.88-2.27 2-4 s 1.25 1.16-1.34 4 s 1.57 1.42-1.73 2-4 s 1.57 1.16-2.11 4 s 2.45 1.76-3.43 <0.001 0.739 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 May, 2025 Read the published version in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine → Version 1 posted Editorial decision: Revision requested 09 Apr, 2025 Reviews received at journal 08 Apr, 2025 Reviews received at journal 07 Apr, 2025 Reviewers agreed at journal 07 Apr, 2025 Reviews received at journal 04 Apr, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviewers agreed at journal 28 Mar, 2025 Reviewers invited by journal 28 Mar, 2025 Editor assigned by journal 27 Mar, 2025 Submission checks completed at journal 27 Mar, 2025 First submitted to journal 25 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6302516","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436478867,"identity":"bf95c00f-c61f-4a03-acd9-6d7dee430c9f","order_by":0,"name":"Sabrina Jegerlehner","email":"data:image/png;base64,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","orcid":"","institution":"Solothurner Spitäler","correspondingAuthor":true,"prefix":"","firstName":"Sabrina","middleName":"","lastName":"Jegerlehner","suffix":""},{"id":436478868,"identity":"ca6b2366-4bcd-4a51-83fd-2c8c2e81b6dd","order_by":1,"name":"Tim Harris","email":"","orcid":"","institution":"Blizzard Institute, Queen Mary University London","correspondingAuthor":false,"prefix":"","firstName":"Tim","middleName":"","lastName":"Harris","suffix":""},{"id":436478869,"identity":"87fb6c13-9bed-4c8b-b79e-f9eeb9e98002","order_by":2,"name":"Martin Mueller","email":"","orcid":"","institution":"Inselspital Bern, University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Mueller","suffix":""},{"id":436478870,"identity":"df7077f3-8e26-44a2-aec6-2c56c55e9070","order_by":3,"name":"Ben Bloom","email":"","orcid":"","institution":"Barts Health NHS Trust","correspondingAuthor":false,"prefix":"","firstName":"Ben","middleName":"","lastName":"Bloom","suffix":""}],"badges":[],"createdAt":"2025-03-25 09:53:33","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6302516/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6302516/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13049-025-01407-1","type":"published","date":"2025-05-12T15:58:01+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80045884,"identity":"20b080a2-16da-4ecb-8abd-4fd1d307ae8a","added_by":"auto","created_at":"2025-04-07 09:46:53","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35970,"visible":true,"origin":"","legend":"\u003cp\u003eStudy overview.\u003c/p\u003e","description":"","filename":"Fig1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6302516/v1/2a022269996792778d8d2b2a.jpg"},{"id":80045891,"identity":"ccd1974f-ad16-4e44-a43f-cfac7bf57607","added_by":"auto","created_at":"2025-04-07 09:46:53","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":73777,"visible":true,"origin":"","legend":"\u003cp\u003eOR for death in different CRT groups depending on haemodynamic parameters (shock versus no shock). CRT: capillary refill time, CI: confidence interval, OR: odds ratio.\u003c/p\u003e","description":"","filename":"Fig2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6302516/v1/638d01d264d92f03941bf04a.jpg"},{"id":83068255,"identity":"1c81e54b-466f-4f6f-b84d-beb54d9f2db3","added_by":"auto","created_at":"2025-05-19 16:10:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":942666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6302516/v1/583404ca-c835-4135-9ced-5b4939ff6a32.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of capillary refill time with mortality in adult trauma patients: a secondary analysis of the CRASH-2 randomised controlled trial data","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eInjuries, whether they result from accidents or acts of violence, claim the lives of 4.4\u0026nbsp;million individuals worldwide annually, accounting for nearly 8% of the total global mortality rate.\u003csup\u003e1\u003c/sup\u003e Haemorrhage accounts for about one third of in-hospital trauma deaths,\u003csup\u003e2\u003c/sup\u003e and contributes to other causes of death such as head injury and organ dysfunction.\u003csup\u003e3\u003c/sup\u003e Failure to identify patients with haemorrhage and institute early treatment increases mortality.\u003csup\u003e4\u003c/sup\u003e However, estimation of the extent of haemorrhage is difficult, especially in compensated shock when haemodynamic parameters are still within normal range.\u003c/p\u003e \u003cp\u003eCRT is defined as the time taken for a skin capillary bed to regain its colour after sufficient pressure has been applied to cause blanching.\u003csup\u003e5\u003c/sup\u003e Vasoconstriction leading to reduced distal capillary bed perfusion is considered an early compensatory mechanism to shock. Delayed reperfusion is a marker of circulatory impairment. CRT may reflect alterations in the microcirculation even when systemic haemodynamics remain normal.\u003csup\u003e6\u003c/sup\u003e Therefore, CRT is advocated as a simple and rapid assessment method for (compensated) shock and is commonly used both in-hospital and pre-hospital.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCRT is widely used in the assessment of ill neonates and children, e.g. for hypovolemia and sepsis a CRT of \u0026le;\u0026thinsp;2 seconds is a treatment target for resuscitation in sepsis, is part of the assessment of circulation in the European Resuscitation Council algorithm for pre-hospital care, and is one of five components of the Trauma Score.\u003csup\u003e6\u0026ndash;11\u003c/sup\u003e Its use is advocated by the adult and paediatric life support algorithms. However, there are few outcome data to support the use of CRT in adult trauma patients.\u003c/p\u003e \u003cp\u003eThe association of CRT with mortality in adult trauma patients was investigated, using data from the CRASH-2 trial. The primary objective was to investigate the association of CRT with 28-day mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP) to assess whether the use of CRT should be advocated.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e\u003cstrong\u003eStudy design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a secondary analysis of the CRASH-2 trial data.\u003csup\u003e12\u003c/sup\u003e CRASH-2 has been previously described.\u003csup\u003e13\u003c/sup\u003e Briefly, CRASH-2 was a randomised controlled trial of tranexamic acid versus placebo in adult patients with trauma and significant haemorrhage. It was conducted in 274 hospitals in 40 countries from May 2005 to January 2010 and included 20,211 adult trauma patients.\u003csup\u003e12\u0026nbsp;\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eFor this study, all 20,207 patients included in CRASH-2 were eligible and those with missing or erroneous data were excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe primary outcome was 28-day mortality, and the secondary outcomes were need for transfusion, surgical intervention and thromboembolic events.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCRT was defined as the time (in seconds) taken for a skin capillary bed to regain its colour after sufficient pressure has been applied to cause blanching, and was measured centrally on the middle of the chest. In the CRASH-2 trial, CRT was collected in seconds. For this study, CRT was categorised as \u0026le; 2, 3-4, and \u0026ge; 5 seconds based on pathological definitions of normal CRT.\u003csup\u003e11, 14-17\u003c/sup\u003e In this trauma patient population, normal BP was defined as systolic blood pressure (SBP)\u0026nbsp;\u0026sup3;\u0026nbsp;100mmHgm and normal HR was defined as\u0026nbsp;\u0026pound;\u0026nbsp;100/minute.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was conducted using\u0026nbsp;STATA 18.0 (MP, StataCorp, College Station, TX, USA). Statistical significance was defined as \u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003eFor the continuous variable we estimated means and standard deviations (SD) or median and interquartile range (IQR) for normally and non-normally distributed data respectively based on Shapiro-Wilk testing. \u0026nbsp;Categorical data were reported as proportions Differences in continuous data were analysed using the \u003cem\u003et\u0026nbsp;\u003c/em\u003etest (normal distribution) or Wilcoxon rank sum test (non-normal distribution); categorial data were compared using the \u003cem\u003echi\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/em\u003etest.\u003c/p\u003e\n\u003cp\u003eFor the primary outcome and all other binary outcomes, odds ratios (ORs), 95% confidence intervals (CIs) and two-sided \u003cem\u003ep\u0026nbsp;\u003c/em\u003evalues for statistical significance were calculated. Univariable and multivariable logistic regression analysis was performed to assess the association of CRT with mortality and all other secondary outcomes. Because patients from different countries represent a nested (clustered) dataset, random effect modelling for countries was used to account for the inter-country variance (clustering). Receiver operating characteristic (ROC) curves were used to assess the discrimination (C statistic, area-under-the-curve [AUC]) of the logistic regression model.\u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOverall, 20,207 patients were included in the original dataset, of whom 611 (4%) did not have a CRT recorded and 543 (3%) had missing or erroneous values and were therefore excluded. The final dataset analysed included 19,054 patients (\u003cstrong\u003eFigure 1\u003c/strong\u003e). Baseline characteristics of the study population are shown in \u003cstrong\u003eTable 1\u003c/strong\u003e. \u0026nbsp;16,000 (84%) patients were male, the median age was 31 (IQR 24-43) years, 10,562 (55%) suffered from blunt trauma and 6,179 (32%) from penetrating trauma. 6,756 (36%) patients had a CRT \u0026le; 2 seconds, 9,142 (48%) from 3-4 seconds, and 3,356 (17%) \u0026ge; 5 seconds. Over the study period of 28 days, 2,802 (15%) patients died, of which 1,154 (6%) died from a head injury, 902 (5%) died from haemorrhage, and 80 (\u0026lt; 1%) patients died from a thromboembolic event\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn multivariable logistic regression analysis, the OR for death was 1.76 (95% CI 1.58-1.95) and 23.21 (95% CI 2.83-3.65) in the CRT categories of 3-4 seconds and \u0026ge; 5 seconds respectively compared to the reference category of \u0026le; 2 seconds (\u003cstrong\u003eTable 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eIn the subgroup of patients with normal HR and BP, i.e., \u0026ldquo;no shock\u0026rdquo;, there was an OR for death of 1.78 (95% CI 1.58-2.00) and 2.69 (95% CI 2.30-3.13) in the CRT categories of 3-4 seconds and \u0026ge; 5 seconds respectively (\u003cstrong\u003eTable 2\u003c/strong\u003e and \u003cstrong\u003eFigure 2\u003c/strong\u003e).\u003c/p\u003e\n\u003cp\u003eSecondary outcomes shown in \u003cstrong\u003eTable 2\u003c/strong\u003e. An increasing CRT was associated with increased risk of transfusion, surgical intervention, and occurrence of thromboembolic events with OR between 1.25-1.57 for CRT of 3-4 seconds and OR of 1.57-2.45 for CRT of \u0026ge; 5 seconds.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003eComparisons with other studies\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study using data from 20,000 trauma patients, increasing CRT was associated with an increased risk of death overall and in subgroups of patients with normal HR and BP. In patients with CRT \u0026ge; 5 seconds there was greater than three-fold risk, and a more than twofold risk of other adverse outcomes such as need for transfusion and occurrence of thromboembolic events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eJouffrouy et al.\u003csup\u003e15\u003c/sup\u003e examined the association of CRT with mortality in patients with septic shock. They found a significant association of CRT values \u0026gt; 4 seconds with 28 day mortality (OR 1.5, 95% CI 1.0-2.4). However, in contrast to our study, this is a retrospective single centre study, and it included patients in septic shock with an overall mortality of 36% - higher than the mortality of the trauma patients in the CRASH-2 trial. Mrgan et al.\u003csup\u003e19\u003c/sup\u003e performed a prospective cohort study with adult acute medical patients. They found an increasing one-day mortality with abnormal CRT; and a high negative predictive value for death with normal CRT. However, those were again medical patients, and with a median age of 66 years they were substantially older than the patients in CRASH-2. Additionally, Mrgan et al. concluded that other vital signs such as HR had a stronger association with death and were therefore better predictors for mortality than CRT.\u003csup\u003e19\u003c/sup\u003e This is contrary to our results, where even patients with normal HR and BP had an increased risk for death when CRT was prolonged.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe test accuracy of CRT assessment with ROC AUC values of about 0.7 is acceptable. These results are in contrast with other studies. In their prospective cohort study, Londono et al.\u003csup\u003e21\u003c/sup\u003e examined the association of clinical hypoperfusion parameters such as CRT with lactate levels and mortality. They found that none of the clinical parameters had an adequate discriminatory capacity to detect hyperlactatemia (AUC \u0026lt; 0.62) or to predict mortality; and that only hyperlactatemia was associated with mortality.\u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThe limitations of CRT as a clinical test are well known with CRT measurements varying with age, gender, temperature, site of assessment and light conditions. \u003csup\u003e17,\u0026nbsp;\u003c/sup\u003e\u003csup\u003e23\u003c/sup\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and limitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is the first to investigate the value of CRT to predict mortality in adult trauma patients using comprehensive and exhaustive data from the multicenter randomised controlled CRASH-2 trial.\u003c/p\u003e\n\u003cp\u003eAdjustment for external and ambient confounders was not possible in this study. However, central CRT was used, which was standardised across all CRASH-2 trial sites, and which is less dependent on temperature. Furthermore, the CRASH-2 trial included patients who were judged to have or to be at risk of on-going significant haemorrhage. These inclusion criteria are purely clinical and could represent a source of selection bias. However, the large number of trial participants in different healthcare settings, and thus heterogeneity of the study population, still guarantees generalisability of the results.\u003c/p\u003e\n\u003cp\u003eThe CRASH-2 study population is predominantly young and male, and these results may not be applicable in other populations.\u003c/p\u003e\n\u003cp\u003eThis study was not designed prospectively to determine a threshold for CRT values above which mortality is increased. However, different cut-offs and definitions for abnormal CRT as previously described in the literature were investigated. There was increasing mortality with rising CRT, and therefore CRT is a continuous rather than a binary predictor for mortality.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn bleeding trauma patients, rising CRT is associated with increased mortality. A CRT\u0026thinsp;\u0026ge;\u0026thinsp;5 seconds is predictive for increased mortality in trauma patients, even when HR and BP are within normal range.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAUC: area under the curve\u003c/p\u003e\n\u003cp\u003eCRASH: clinical randomisation of an antifibrinolytic in significant haemorrhage\u003c/p\u003e\n\u003cp\u003eCRT: capillary refill time\u003c/p\u003e\n\u003cp\u003eCI: confidence Interval\u003c/p\u003e\n\u003cp\u003eDCRT: digital CRT\u003c/p\u003e\n\u003cp\u003eHR: heart rate\u003c/p\u003e\n\u003cp\u003eIQR: interquartile range\u003c/p\u003e\n\u003cp\u003eOP: operation\u003c/p\u003e\n\u003cp\u003eOR: odds ratio\u003c/p\u003e\n\u003cp\u003eROC: receiver operating characteristic curves\u003c/p\u003e\n\u003cp\u003eRR: relative risk\u003c/p\u003e\n\u003cp\u003eSBP: systolic blood pressure\u003c/p\u003e\n\u003cp\u003eSD: standard deviation\u003c/p\u003e\n\u003cp\u003eTXA: tranexamic acid\u003c/p\u003e\n\u003cp\u003eVTE: venous thromboembolic event\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was conducted in accordance with the Declaration of Helsinki, ensuring adherence to ethical principles for medical research involving human subjects. The CRASH-2 trial had UK Research Ethics Committee approval and was approved by the relevant ethics committees in all 274 participating hospitals. Informed consent procedures were established by local regulation and the appropriate ethics committees. The Data Monitoring and Ethics Committee (DMEC) had the responsibility for randomization. This is a secondary analysis of data from this trial, and therefore no additional ethics approval was needed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCRASH-2 data is publicly available.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf, and declare that they do not have any competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTH, BB and SJ conceived the study. MM analysed the data and provided statistical expertise. SJ wrote the first draft of the paper. All authors contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The authors assume full responsibility for analyses and interpretation of these data. SJ is the guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ehttps://www.who.int/news-room/fact-sheets/detail/injuries-and-violence - Date: 2021\u003c/li\u003e\n\u003cli\u003eSauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995; 38:185-93.\u003c/li\u003e\n\u003cli\u003eKauvar DS, Lefering R, Wade CE. Impact of haemorrhage on trauma outcome: an overview of epidemiology, clinical presentations, and therapeutic considerations. J Trauma 2006;60:S3-11\u003c/li\u003e\n\u003cli\u003eTien HC, Spencer F, Tremblay LN, et al. Preventable deaths from haemorrhage at a level I Canadian trauma centre. J Trauma 2007;62(1):142-46\u003c/li\u003e\n\u003cli\u003eBeecher HK, Simeone FA, Burnett CH, e al. The internal state of the severely wounded man on entry to the most forward hospital. Surgery. 1947:22;672-711.\u003c/li\u003e\n\u003cli\u003ePickard A, Karlen W, Ansermino JM. Capillary refill time: Is it still a useful clinical sign? Anesth Analg. 2011; 113:120-3.\u003c/li\u003e\n\u003cli\u003eHarrison TR, ed. Harrison\u0026rsquo;s Principles of Internal Medicine. 14th ed. New York: McGraw-Hill, 1998.\u003c/li\u003e\n\u003cli\u003eHazinski MF, Zaritsky AL, Nadkarni VM, eds. PALS Provider Manual. Dallas: American Heart Association, 2002.\u003c/li\u003e\n\u003cli\u003eRhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: international guideliens for management of severe sepsis and septic shock: 2016. Intensive Care Med 2017;43(3):304-377.\u003c/li\u003e\n\u003cli\u003eMonsieurs KG, Nolan JP, Bossaert LL, et al. European Resuscitation Council guidelines of resuscitation 2015. Section 1: executive summary. Resuscitation 2015; 95:1-80.\u003c/li\u003e\n\u003cli\u003eChampion HR, Sacco WJ, Carnazzo AJ, et al. Trauma score. Crit Care Med.1981 Sep;9(9):672-6.\u003c/li\u003e\n\u003cli\u003eCRASH-2 trial collaborators, Shakur H, Roberts I, et al. Effects of tranexamic acid in death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet. 2010:376(9734);23-32.\u003c/li\u003e\n\u003cli\u003eThe CRASH Trials Co-ordinating Centre. Protocol 05PRT/1: The CRASH-2 (Clinical Randomization of an Anti-fibrinolytic in Significant Haemorrhage) trial. The Lancet 2005.\u003c/li\u003e\n\u003cli\u003eLewin J, Maconochie I. Capillary refill time in adults. EMJ 2008;25:325-6.\u003c/li\u003e\n\u003cli\u003eJouffroy R, Saade A, Tourtier JP, et al. Skin mottling score and capillary refill time to assess mortality of septic shock since prehospital setting. Am J Emerg Med. 2019 Apr;37(4):664-671.\u003c/li\u003e\n\u003cli\u003eEspinoza ED, Welsh S, Dubin A. Lack of agreement between different observers and methods in the measurement of capillary refill time in healthy volunteers: an observational study. Rev Bras Ter Intensiva. 2014;26(3):269\u0026ndash;276.\u003c/li\u003e\n\u003cli\u003eSchriger D, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988;17:932-5.\u003c/li\u003e\n\u003cli\u003eDeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837-845.\u003c/li\u003e\n\u003cli\u003eMrgan M, Rytter D, Brabrand N. Capillary refill time is a predictor of short-term mortality for adult patients admitted to a medical department: an observational cohort study. Emerg Med J 2014;31:954\u0026ndash;958.\u003c/li\u003e\n\u003cli\u003eNickel A, Jiang S, Napolitano N, et al. Abstract 276: Impact of Skin Color on Accuracy of Capillary Refill Time Measurement by Pulse Oximeter. Circulation. 2018;138:A276.\u003c/li\u003e\n\u003cli\u003eLondono J, Nino C, Diaz J, et al. Association of clinical hypoperfusion with lactate clearance and mortality. Shock. 2018;286-292.\u003c/li\u003e\n\u003cli\u003eAnderson B, Kelly AM, Kerr D, et al. Capillary refill time in adults has poor interobserver agreement. Hong Kong J Emerg Med 2008;15:71\u0026ndash;4\u003c/li\u003e\n\u003cli\u003eBrown LH, Prasad NH, Whitley TW. Adverse lighting condition effects on the assessment of capillary refill. Am J Emerg Med 1994;12:46\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eShavit I, Brant R, Nijssen-Jordan C, et al. A novel imaging technique to measure capillary-refill time: improving diagnostic accuracy for dehydration in young children with gastroenteritis. Pediatrics 2006;118:2402-8\u003c/li\u003e\n\u003cli\u003eKviesis-Kipge E, Curkste E, Spigulis J, et al. Optical Studies of the Capillary Refill Kinetics in Fingertips. Doessel O, Schlegel WC, eds. World Congress on Medical Physics and Biomedical Engineering, 2009, Munich, Germany. Berlin: Springer, 2009:377-9 \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. Baseline characteristics of the study patients. CRT: capillary refill time, HR: heart rate, N: absolute count, OP: need for surgical intervention, RR: respiratory rate, s: seconds, SBP: systolic blood pressure, VTE: thromboembolic event.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n=19,054\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvived n=16,252\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeath n=2801\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[24; 43]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[23; 42]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[25; 48]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e16-40 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e13,716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[72.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e11,929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[73.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[63.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e41-65 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e4,575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[24.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e3,785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[23.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e790\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[28.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e66-80 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[3.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[3.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[6.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026gt;80 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[0.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[0.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[1.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e16,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e13,656\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[84.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2,344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[83.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3,054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[16.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2,596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[16.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[16.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of injury\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eBlunt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e10,562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[55.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e8,794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[54.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[63.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003ePenetrating\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e6,179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[32.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e5,567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[34.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e612\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[21.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eCombined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2,313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[12.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e1,891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[11.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[15.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVital parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eSBP (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[80; 110]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[86; 111]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[70; 100]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eHR (per minute)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[90; 120]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[90; 118]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[96; 126]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eRR (per minute)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[20; 26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[20; 26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[20; 30]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eShock\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3,077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[16.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2,242\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[13.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[29.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e0-2s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e6756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[35.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e6069\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[37.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[24.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026gt;2-4s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e9142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[48.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e7772\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[47.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[48.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u0026gt;4s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e3156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[16.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e2411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[14.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[26.6]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28-day mortality\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eSurvived\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e16,252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[85.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e16,252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[0.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2,802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[14.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[0.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e2,802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[100.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCause of death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eBleed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[4.7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e902\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[32.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eHead injury\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[6.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[41.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eVTE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[0.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[2.9]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[3.5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003en.a.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e666\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[23.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSecondary outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eTransfusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e9,534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[50.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e7,702\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[47.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,832\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[65.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eOP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e9,580\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[50.3]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e8,139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[50.1]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1,441\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[51.4]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e0.188\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20px;\"\u003e\n \u003cp\u003eVTE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e[1.8]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10px;\"\u003e\n \u003cp\u003e[1.2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e[5.0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Multivariable logistic regression analysis: OR for 28-day mortality by CRT category against reference category (CRT \u0026le; 2 s). AUC: area under the curve, CI: confidence interval, CRT: capillary refill time, OR: odds ratio, s: seconds, VTE: venous thromboembolic event.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"538\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR death all\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.58-1.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.83-3.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR death in shock\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.15-1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.86-3.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR death no shock\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.58-2.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e2.30-3.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR transfusion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.30-1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.88-2.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.663\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR OP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.16-1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.42-1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCRT group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR VTE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e0-2 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 2-4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e1.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.16-2.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026gt; 4 s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 170px;\"\u003e\n \u003cp\u003e2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.76-3.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0.739\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"emergency medicine, capillary refill time, trauma, mortality, shock, pre-hospital","lastPublishedDoi":"10.21203/rs.3.rs-6302516/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6302516/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Trauma-related injuries account for up to 4.4 million deaths annually worldwide. Failure to identify haemorrhage in trauma patients increases mortality. This study examines the association of capillary refill time (CRT) and mortality in adult trauma patients, especially in the subgroup with normal heart rate (HR) and blood pressure (BP).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This retrospective observational study analysed data from the CRASH-2 trial, conducted in 274 hospitals across 40 countries and 5 continents between May 2005 and January 2010. A total of 19,054 out of 20,207 adult trauma patients with recorded CRT and complete dataset were included. CRT was categorized as ≤ 2, 3-4, and ≥ 5 seconds. The primary outcome was 28-day mortality, while secondary outcomes included need for transfusion, surgical intervention and thromboembolic events. Univariable and multivariable logistic regression analysis were conducted, incorporating random effects for continent/cluster. Receiver operating characteristic curves were used to assess the discriminatory ability of CRT measurement\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Among the patients, 6,756 (35.5%) had a CRT ≤2 seconds, 9,142 (48%) had a CRT of 3–4 seconds, and 3,156 (16.6%) had a CRT ≥5 seconds. Compared to the reference category (CRT ≤2 seconds), the odds of death were significantly higher in patients with CRT of 3–4 seconds (OR 1.7, 95% CI 1.6–1.9) and CRT ≥5 seconds (OR 3.2, 95% CI 2.8–3.5). Higher CRT was also associated with an increased likelihood of blood transfusion, surgical intervention, and thromboembolic events. However, CRT demonstrated poor test accuracy for mortality prediction, with area under the curve (AUC) values around 0.6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: CRT is associated with increased mortality and adverse outcomes in trauma patients. However, due to its low predictive accuracy, CRT alone is insufficient as a screening tool in pre-hospital settings. Nevertheless, it may provide additional value in patients with normal blood pressure and heart rate. In bleeding trauma patients, an increasing CRT is linked to higher mortality risk, with a CRT ≥5 seconds being particularly predictive of worse outcomes, even in patients with stable vital signs.\u003c/p\u003e","manuscriptTitle":"Association of capillary refill time with mortality in adult trauma patients: a secondary analysis of the CRASH-2 randomised controlled trial data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-07 09:46:48","doi":"10.21203/rs.3.rs-6302516/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-09T09:19:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-08T13:18:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-07T08:49:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33887024355077103514639016873715146544","date":"2025-04-07T07:38:42+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-04T08:05:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"163325522024081342293898411519853108996","date":"2025-03-28T10:07:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"116072183903976961512520511257425922764","date":"2025-03-28T08:57:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102442237485044880120493594991167003090","date":"2025-03-28T08:56:01+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-28T08:28:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-27T11:14:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-27T11:11:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","date":"2025-03-25T09:51:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"stre","sideBox":"Learn more about [Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine](http://sjtrem.biomedcentral.com)","snPcode":"13049","submissionUrl":"https://submission.nature.com/new-submission/13049/3","title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine","twitterHandle":"@SJTREM","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d61be929-2d4c-4b2a-b22f-80e73f820078","owner":[],"postedDate":"April 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-05-19T16:07:40+00:00","versionOfRecord":{"articleIdentity":"rs-6302516","link":"https://doi.org/10.1186/s13049-025-01407-1","journal":{"identity":"scandinavian-journal-of-trauma-resuscitation-and-emergency-medicine","isVorOnly":false,"title":"Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine"},"publishedOn":"2025-05-12 15:58:01","publishedOnDateReadable":"May 12th, 2025"},"versionCreatedAt":"2025-04-07 09:46:48","video":"","vorDoi":"10.1186/s13049-025-01407-1","vorDoiUrl":"https://doi.org/10.1186/s13049-025-01407-1","workflowStages":[]},"version":"v1","identity":"rs-6302516","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6302516","identity":"rs-6302516","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}