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which may have contributed to changes in coagulopathy as 5. Ward RT, Colton DM, Meade PC, et al. Serum levels of calcium
well as the number of trauma patients seen at this time of year. and albumin in survivors versus nonsurvivors after critical injury.
This study was completed utilizing chart review, which could J Crit Care. 2004;19(1):54–64.
contain human error. 6. Giancarelli A, Birrer KL, Alban RF, et al. Hypocalcemia in trauma
patients receiving massive transfusion. J Surg Res. 2016;202(1):
182–187.
Conclusion 7. Ho KM, Leonard AD. Concentration-dependent effect of hypo-
calcaemia on mortality of patients with critical bleeding requir-
Half of trauma patients presenting from an out-of-hospital ing massive transfusion: a cohort study. Anaesth Intensive Care.
setting were hypocalcemic, with severe hypocalcemia iden- 2011;39(1):46–54.
tified in two patients. The results of this retrospective chart 8. Moore HB, Tessmer MT, Moore EE, et al. Forgot calcium? Ad-
review agree with current literature regarding identifying the mission ionized-calcium in two civilian randomized controlled
trials of pre-hospital plasma for traumatic hemorrhagic shock. J
correlation between hypocalcemia and trauma patients. The Trauma Acute Care Surg. 2020;88(5):588–596.
administration of calcium supplementation empirically in 9. Steele T, Kolamunnage-Dona R, Downey C, et al. Assessment
trauma patients in the prehospital setting is not recommended and clinical course of hypocalcemia in critical illness. Crit Care.
until further data prove it beneficial. 2013;17(3):R10.
10. Magnotti LJ, Bradburn EH, Webb DL, et al. Admission ionized
calcium levels predict the need for multiple transfusions: a pro-
Author Contributions spective study of 591 critically ill trauma patients. J Trauma.
CL conceived the study concept. TW, MB, JM, and CW opted 2011;70(2):391–395.
to proceed with the study. JH, JB, CW, and CL coordinated 11. Cherry RA, Bradburn E, Carney DE, et al. Do early ionized cal-
and collected the data. LL analyzed the data. JH and CL dis- cium levels really matter in trauma patients. J Trauma. 2006;61(4):
seminated results. KB and LL wrote the first draft. All authors 774–779.
read and approved the final manuscript. 12. Vasudeva M, Mathew JK, Fitzgerald MC, et al. Hypocalcemia
and traumatic coagulopathy: an observed analysis. Vox Sang.
2020;115(2);189-195.
Disclosure 13. Vivien B, Langeron O, Morell E, et al. Early hypocalcemia in se-
None. vere trauma. Crit Care Med. 2005;33(9):1946–1952.
14. Webster S, Todd S, Redhead J, et al. Ionized calcium levels in ma-
Funding jor trauma patients who received blood in the emergency depart-
None. ment. Emerg Med J. 2016;33(8):569–575.
15. Blackney D. Prehospital administration of calcium in trauma.
J Paramed Pract. 2022;14(7).
References 16. Leech C, Clarke E. Pre-hospital blood products and calcium re-
1. Ditzel RM, Anderson JL, Eisenhart WJ, et al. A review of transfusion- placement protocols in UK critical care services: A survey of cur-
and trauma-induced hypocalcemia: Is it time to change the lethal rent practice. Resusc Plus. 2022;100282.
triad to the lethal diamond? J Trauma Acute Care Surg. 2020;88 17. Bolorunduro OB, Villegas C, Oyetunji TA, et al. Validating the
(3):434–439. Injury Severity Score (ISS) in different populations: ISS pre-
2. Wray JP, Bridwell RE, Schauer SG, et al. The diamond of death: hy- dicts mortality better among Hispanics and females. J Surg Res.
pocalcemia in trauma and resuscitation. Am J Emerg Med. 2021; 2011;166(1):40–44.
41:104–109. 18. MacKay EJ, Stubna MD, Holena DN, et al. Abnormal calcium
3. Calvi LM, Bushinsky DA. When is it appropriate to order an ion- levels during trauma resuscitation are associated with increased
ized calcium? J Am Soc Nephrol. 2008;19:1257–1260. mortality, increased blood product use, and greater hospital re-
4. Heidle JA, Liccardi C, White C, et al. Prevalence assessment of source consumption: A pilot investigation. Anesth Analg. 2017;
hypocalcemia in the hypovolemic trauma patients. TQIP Annual 125(3):895–901.
Conference. Feb 2020.
PMID: 37094288; DOI: 10.55460/WYEJ-1M3J

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