Hypercalcemia After Trauma Linked to Higher Mortality Despite Lower Prevalence: JAMA
USA: Researchers have discovered in a cohort study of trauma patients that hypercalcemia was less frequent than hypocalcemia but was associated with higher mortality at all time points. Both hypercalcemia and hypocalcemia were linked to increased blood product use compared with eucalcemia, with similar transfusion requirements across calcium abnormalities. These findings highlight the need for prospective interventional trials to clarify the role and impact of empiric calcium treatment.
The study, published in JAMA Network Open, was led by Steven G. Schauer of the US Army Institute of Surgical Research, JBSA Ft Sam Houston, Texas, and colleagues. The investigators aimed to determine how often calcium imbalances are present upon arrival to the emergency department (ED) after major trauma and whether these abnormalities are associated with clinical outcomes.
The prospective, multicenter cohort study was conducted between 2022 and 2024 at three American College of Surgeons–verified level I trauma centers in the United States. The study enrolled 1,270 patients who met criteria for the highest level of trauma activation and arrived within 24 hours of injury. Ionized calcium levels were measured immediately upon ED arrival, with values categorized as hypocalcemia, eucalcemia, or hypercalcemia based on established reference ranges.
Among the participants, 22% were found to be hypocalcemic, 73% had normal calcium levels, and 5% were hypercalcemic. Motor vehicle collisions and firearm-related injuries were the most common mechanisms of trauma. The median age of participants was 35 years, and the majority were male.
The analysis revealed the following findings:
- At 24 hours, mortality was 11.9% in patients with hypocalcemia and 22.8% in those with hypercalcemia, compared with 4.3% among patients with normal calcium levels.
- The risk of death increased as calcium abnormalities became more severe, demonstrating a U-shaped association between calcium levels and mortality.
- Injury severity scores were higher in patients with either hypocalcemia or hypercalcemia compared with those who were eucalcemic.
- Within the first 24 hours, 64.1% of hypocalcemic patients and 66.7% of hypercalcemic patients required blood product transfusions, compared with 31.5% of patients with normal calcium levels.
- Transfusion requirements were similar between the hypocalcemic and hypercalcemic groups.
The authors acknowledge several limitations, including the observational design, which restricts causal interpretation. Most patients were enrolled at a single center, potentially affecting generalizability. Additionally, some eligible patients were not captured if ionized calcium levels were not measured on arrival, and reliance on documented prehospital data may have introduced inaccuracies.
Ongoing research, including a Department of Defense–funded trial evaluating empiric calcium administration during early resuscitation, is expected to provide further insight. The investigators conclude that while hypercalcemia is less common than hypocalcemia in major trauma, it appears to carry a greater mortality risk, highlighting the need for interventional studies to better understand optimal calcium management strategies in this population.
Reference:
Schauer SG, Nicholson SE, Rizzo JA, et al. Initial Calcium Derangements in Major Trauma and Outcomes. JAMA Netw Open. 2026;9(2):e260083. doi:10.1001/jamanetworkopen.2026.0083
Next Story