Academic Journal
TRAUMA-INDUCED COAGULOPATHY: PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER.
| Τίτλος: | TRAUMA-INDUCED COAGULOPATHY: PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER. |
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| Συγγραφείς: | Teeter W, Neal MD, Brown JB, MacLeod JBA; Department of Surgery, Kenyatta University, College of Health Sciences, Nairobi, Kenya., Vesselinov R, Kozar RA; R Adams Cowley Shock Trauma Center and the Shock Trauma Anesthesiology Research (STAR) Center, University of Maryland School of Medicine, Baltimore, Maryland. |
| Πηγή: | Shock (Augusta, Ga.) [Shock] 2024 Sep 01; Vol. 62 (3), pp. 380-385. Date of Electronic Publication: 2024 Jun 24. |
| Τύπος έκδοσης: | Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 9421564 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1540-0514 (Electronic) Linking ISSN: 10732322 NLM ISO Abbreviation: Shock Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2002- : Philadelphia : Lippincott Williams & Wilkins Original Publication: Augusta, GA : BioMedical Press, [1994- |
| Ιατρικοί όροι (MeSH): | Blood Coagulation Disorders*/etiology , Blood Coagulation Disorders*/mortality , Blood Coagulation Disorders*/epidemiology , Wounds and Injuries*/complications , Wounds and Injuries*/mortality , Wounds and Injuries*/blood, Humans ; Male ; Middle Aged ; Female ; Retrospective Studies ; Adult ; Prevalence ; Aged ; Injury Severity Score ; Trauma Centers |
| Περίληψη: | Abstract: Introduction: A 2003 landmark study identified the prevalence of early trauma-induced coagulopathy (eTIC) at 28% with a strong association with mortality of 8.9%. Over the last 20 years, there have been significant advances in both the fundamental understanding of eTIC and therapeutic interventions. Methods: A retrospective cohort study was performed from 2018 to 2022 on patients ≥18 using prospectively collected data from two level 1 trauma centers and compared to data from 2003. Demographics, laboratory data, and clinical outcomes were obtained. Results: There were 20,107 patients meeting criteria: 65% male, 85% blunt, mean age 54 ± 21 years, median Injury Severity Score 10 (10, 18), 8% of patients were hypotensive on arrival, with an all-cause mortality 6.0%. The prevalence of eTIC remained high at 32% in patients with an abnormal prothrombin time and 10% with an abnormal partial thromboplastin time, for an overall combined prevalence of 33.4%. Coagulopathy had a major impact on mortality over all injury severity ranges, with the greatest impact with lower Injury Severity Score. In a hybrid logistic regression/Classification and Regression Trees analysis, coagulopathy was independently associated with a 2.1-fold increased risk of mortality (95% confidence interval 1.5-2.9); the predictive quality of the model was excellent [area under the receiver operating characteristic curve (AUROC) 0.932]. Conclusion: The presence of eTIC conferred a higher risk of death across all disease severities and was independently associated with a greater risk of death. Biomarkers of coagulopathy associated with eTIC remain strongly predictive of poor outcome despite advances in trauma care. (Copyright © 2024 by the Shock Society.) |
| Competing Interests: | The authors report no conflicts of interest. |
| References: | Kalkwarf KJ, Drake SA, Yang Y, et al. Bleeding to death in a big city: an analysis of all trauma deaths from hemorrhage in a metropolitan area during 1 year. J Trauma Acute Care Surg . 2020;89(4):716–722. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg . 2012;73(6 Suppl 5):S431–S437. Kashuk JL, Moore EE, Millikan JS, et al. Major abdominal vascular trauma—a unified approach. J Trauma . 1982;22(8):672–679. MacLeod JB, Lynn M, McKenney MG, et al. Early coagulopathy predicts mortality in trauma. J Trauma . 2003;55(1):39–44. Brohi K, Singh J, Heron M, et al. Acute traumatic coagulopathy. J Trauma . 2003;54(6):1127–1130. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma . 2007;63(4):805–813. Sperry JL, Guyette FX, Brown JB, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med . 2018;379(4):315–326. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA . 2015;313(5):471–482. Guyette FX, Zenati M, Triulzi DJ, et al. Prehospital low titer group O whole blood is feasible and safe: results of a prospective randomized pilot trial. J Trauma Acute Care Surg . 2022;92(5):839–847. Moore HB, Moore EE, Chapman MP, et al. Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial. Lancet . 2018;392(10144):283–291. Shakur H, Roberts I, Bautista R, et al. Effects of tranexamic acid on 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. (In eng). Guyette FX, Brown JB, Zenati MS, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg . 2020;156(1):11–20. Moore EE, Chin TL, Chapman MC, et al. Plasma first in the field for postinjury hemorrhagic shock. Shock . 2014;41(suppl 1(0 1)):35–38. (In eng). Gruen DS, Brown JB, Guyette FX, et al. Prehospital plasma is associated with distinct biomarker expression following injury. JCI Insight . 2020;5(8):e135350. Floccard B, Rugeri L, Faure A, et al. Early coagulopathy in trauma patients: an on-scene and hospital admission study. Injury . 2012;43(1):26–32. Moore HB, Neal MD, Bertolet M, et al. Proteomics of coagulopathy following injury reveals limitations of using laboratory assessment to define trauma-induced coagulopathy to predict massive transfusion. Ann Surg Open . 2022;3(2):e167. |
| Grant Information: | R01 GM140983 United States GM NIGMS NIH HHS; R01 HL166944 United States HL NHLBI NIH HHS |
| Entry Date(s): | Date Created: 20240626 Date Completed: 20240830 Latest Revision: 20250815 |
| Update Code: | 20260130 |
| DOI: | 10.1097/SHK.0000000000002416 |
| PMID: | 38920139 |
| Βάση Δεδομένων: | MEDLINE |
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