BACKGROUND: Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio >/=1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian trauma patients. METHODS: A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality. RESULTS: A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6). CONCLUSIONS: The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian trauma patients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian trauma patients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes.
BACKGROUND: Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio >/=1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian traumapatients. METHODS: A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality. RESULTS: A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6). CONCLUSIONS: The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian traumapatients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian traumapatients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes.
Authors: Mareike Kristina Keller; Axel Pruss; Michael Sander; Claudia Spies; Helge Schoenfeld; Michael Schuster; Kristian Meinck; Klaus-Dieter Wernecke; Christian Von Heymann Journal: Blood Transfus Date: 2012-03-28 Impact factor: 3.443
Authors: Lisa M Brown; Mariah S Call; M Margaret Knudson; Mitchell J Cohen; J B Holcomb; C E Wade; K J Brasel; G Vercruysse; J MacLeod; R P Dutton; J R Hess; J C Duchesne; N E McSwain; P Muskat; J Johannigamn; H M Cryer; A Tillou; J F Pittet; M A De Moya; M A Schreiber; B Tieu; S Brundage; L M Napolitano; M Brunsvold; M Brunsvold; G Beilman; A B Peitzman; M S Zenait; J Sperry; L Alarcon; M A Croce; J P Minei; R Kozar; E A Gonzalez; R M Stewart; S M Cohn; J E Mickalek; E M Bulger; B A Cotton; T C Nunez; R Ivatury; J W Meredith; P Miller; G J Pomper; B Marin Journal: J Trauma Date: 2011-08
Authors: Lisa M Brown; Seppo O Aro; Mitchell J Cohen; J B Holcomb; C E Wade; K J Brasel; G Vercruysse; J MacLeod; R P Dutton; J R Hess; J C Duchesne; N E McSwain; P Muskat; J Johannigamn; H M Cryer; A Tillou; J F Pittet; P Knudson; M A De Moya; M A Schreiber; B Tieu; S Brundage; L M Napolitano; M Brunsvold; K C Sihler; G Beilman; A B Peitzman; M S Zenait; J Sperry; L Alarcon; M A Croce; J P Minei; R Kozar; E A Gonzalez; R M Stewart; S M Cohn; J E Mickalek; E M Bulger; B A Cotton; T C Nunez; R Ivatury; J W Meredith; P Miller; G J Pomper; B Marin Journal: J Trauma Date: 2011-08
Authors: Nathan J White; Jason C Newton; Erika J Martin; Bassem M Mohammed; Daniel Contaifer; Jessica L Bostic; Gretchen M Brophy; Bruce D Spiess; Anthony E Pusateri; Kevin R Ward; Donald F Brophy Journal: Shock Date: 2015-08 Impact factor: 3.454
Authors: Ruth S Hwu; Philip C Spinella; Martin S Keller; David Baker; Michael Wallendorf; Julie C Leonard Journal: Transfusion Date: 2016-08-29 Impact factor: 3.157
Authors: Zayde A Radwan; Yu Bai; Nena Matijevic; Deborah J del Junco; James J McCarthy; Charles E Wade; John B Holcomb; Bryan A Cotton Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766