ArticleWorld journal of emergency surgery : WJES2025
Comparison of the lethal triad and the lethal diamond in severe trauma patients: a multicenter cohort.
Article in World journal of emergency surgery : WJES, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Brazilian consensus on the management of bleeding complications related to the use of oral anticoagulants.Revista da Associacao Medica Brasileira (1992) · 2026Guideline
- Development and Validation of a Simplified Five-Variable Score for Predicting Massive Transfusion in Blunt-Trauma-Predominant Patients.Journal of clinical medicine · 2026Article
- A stochastic, physiology-based digital twin model of hemostasis and oxygenation in trauma resuscitation.Research square · 2026Article
- Prognostic impact of body temperature trajectories from emergency department arrival to intensive care unit admission - insights from the TraumaRegister DGUScandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Prognostic value of severe hypocalcemia in predicting mortality and transfusion in moderate-to-severe trauma.BMC emergency medicine · 2026Article
- The Importance of the "Damage Control" Strategy in Multiple Organ Injuries, Pathophysiology and Principles of Hemorrhage Control.Journal of clinical medicine · 2026Review
- Artificial intelligence-driven clustering for phenotyping life-threatening prehospital trauma.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Article
- Blood Product Transfusion and Coagulopathy in Children with Traumatic Brain Injury: A Narrative Review.Children (Basel, Switzerland) · 2026Review
- Current operative approaches for necrotizing enterocolitis.World journal of pediatric surgery · 2026Review
- The application of a new type of intestinal diversion devices in Beagle dogs with intestinal transection injury and hemorrhagic shock.Frontiers in bioengineering and biotechnology · 2026Article
- Initial management of haemorrhagic war casualties: tactical priorities and innovative approaches in modern and future warfare.Critical care (London, England) · 2025Review
- Development of an automated machine learning-based prediction model and interactive tool for blood transfusion requirements in patients with severe traumatic brain injury.Frontiers in neurologyArticle
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Authors and funding
28 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundTo reduce the number of deaths caused by exsanguination, the initial management of severe trauma aims to prevent, if not limit, the lethal triad, which consists of acidosis, coagulopathy, and hypothermia. Recently, several studies have suggested adding hypocalcemia to the lethal triad to form the lethal diamond, but the evidence supporting this change is limited. Therefore, the aim of this study was to compare the lethal triad and lethal diamond for their respective associations with 24-h mortality in severe trauma patients receiving transfusion.
methodsWe performed a multicenter retrospective analysis of patients in TraumaBase®, a French database (2011-2023). The patients included in this study were all trauma patients who had received transfusions of at least 1 unit of red blood cells (RBCs) within the first 6 h of hospital admission and for whom ionized calcium measurements were available. Hypocalcemia was defined as an ionized calcium level < 1.1 mmol/L.
resultsA total of 2141 severe trauma patients were included (median age: 39, interquartile range [IQR]: 26-57; median injury severity score: 27, IQR: 17-41). Patients primarily presented with blunt trauma (81.7%), and a 24-h mortality rate of 16.1% was observed. Receiver operating characteristic curve analysis revealed no significant difference in the association with 24-h mortality between the lethal diamond (area under the curve [AUC]: 0.71) and the lethal triad (AUC: 0.72) (p = 0.26). The strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer's V values of 0.29 and 0.28, respectively.
conclusionsThis study revealed no significant difference between the lethal triad and the lethal diamond in terms of their respective associations with 24-h mortality in severe trauma patients requiring transfusion. These results raise questions about the independent role of hypocalcemia in early mortality.
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