Jana B A MacLeod1, Anne M Winkler2, Cameron C McCoy3, Christopher D Hillyer4, Beth H Shaz5. 1. Study completed while author at the Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States; Karen Hospital, Department of Surgery, Nairobi, Kenya. Electronic address: janamac@outlook.com. 2. Departments of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States. 3. Duke University, Surgical Residency, Department of Surgery, Durham, NC, United States. 4. New York Blood Center, New York, NY, United States. 5. Departments of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, United States; New York Blood Center, New York, NY, United States.
Abstract
INTRODUCTION: Newer studies have hypothesised about a coagulopathy that occurs early after trauma, early trauma induced coagulopathy, ETIC, and is defined by an elevated admission prothrombin time (PT). Also, referred to by some authors as acute traumatic coagulopathy, it has been most often studied in cohorts of severely injured or hypotensive patients. However, we wanted to prospectively investigate ETIC in a large all-comers cohort to confirm its prevalence across the entire spectrum of injury, to evaluate its risk pattern and to determine a possible relationship to reduced survival. METHODS: We conducted a prospective cohort study at a Level I trauma centre from July 15, 2008 to November 15, 2009. Demographics, injury mechanism, time from injury and to hospital arrival, fluid and blood administration and vital signs were collected at hospital arrival and to the time of first blood sample collection for all patients admitted for 24h or longer. Our primary outcome was the incidence of mortality by the 28th hospital day, referred to as 28 day in-hospital mortality. RESULTS: 701 patients were included in the final study cohort. There was 75.3% male, 25.7% penetrating, with a mean age of 39 years. The overall mortality was 7.3%. ETIC occurred in 114 patients (16.3%) and was found to be independently associated with death (odds of death (per 0.10s increase in PT): 1.10, p=0.001). ETIC patients, as a group, were more severely injured, had more hypotension and head injury and used more crystalloid and blood products than non-ETIC patients. However, even mildly injured patients, who had an ISS<16, normal RTS score, and no fluid resuscitation, had an ETIC prevalence of 11.7% (11/94). CONCLUSIONS: ETIC is an early, primary post-injury coagulopathy that occurs in 16.3% of admitted trauma patients. It is associated with an increase in mortality, even when controlling for crystalloids, vital signs, injury severity and head injury. It can also be found in approximately 11% of mildly injured patients (patients without physiological derangement or blood product administration). Therefore, further elucidation of ETIC is strategic to impacting trauma patient outcome.
INTRODUCTION: Newer studies have hypothesised about a coagulopathy that occurs early after trauma, early trauma induced coagulopathy, ETIC, and is defined by an elevated admission prothrombin time (PT). Also, referred to by some authors as acute traumatic coagulopathy, it has been most often studied in cohorts of severely injured or hypotensivepatients. However, we wanted to prospectively investigate ETIC in a large all-comers cohort to confirm its prevalence across the entire spectrum of injury, to evaluate its risk pattern and to determine a possible relationship to reduced survival. METHODS: We conducted a prospective cohort study at a Level I trauma centre from July 15, 2008 to November 15, 2009. Demographics, injury mechanism, time from injury and to hospital arrival, fluid and blood administration and vital signs were collected at hospital arrival and to the time of first blood sample collection for all patients admitted for 24h or longer. Our primary outcome was the incidence of mortality by the 28th hospital day, referred to as 28 day in-hospital mortality. RESULTS: 701 patients were included in the final study cohort. There was 75.3% male, 25.7% penetrating, with a mean age of 39 years. The overall mortality was 7.3%. ETIC occurred in 114 patients (16.3%) and was found to be independently associated with death (odds of death (per 0.10s increase in PT): 1.10, p=0.001). ETIC patients, as a group, were more severely injured, had more hypotension and head injury and used more crystalloid and blood products than non-ETIC patients. However, even mildly injured patients, who had an ISS<16, normal RTS score, and no fluid resuscitation, had an ETIC prevalence of 11.7% (11/94). CONCLUSIONS: ETIC is an early, primary post-injury coagulopathy that occurs in 16.3% of admitted traumapatients. It is associated with an increase in mortality, even when controlling for crystalloids, vital signs, injury severity and head injury. It can also be found in approximately 11% of mildly injured patients (patients without physiological derangement or blood product administration). Therefore, further elucidation of ETIC is strategic to impacting traumapatient outcome.
Authors: Anirban Banerjee; Christopher C Silliman; Ernest E Moore; Monika Dzieciatkowska; Marguerite Kelher; Angela Sauaia; Kenneth Jones; Michael P Chapman; Eduardo Gonzalez; Hunter B Moore; Angelo D'Alessandro; Erik Peltz; Benjamin E Huebner; Peter Einerson; James Chandler; Arsen Ghasabayan; Kirk Hansen Journal: J Trauma Acute Care Surg Date: 2018-06 Impact factor: 3.313
Authors: Michael P Chapman; Ernest E Moore; Hunter B Moore; Eduardo Gonzalez; Fabia Gamboni; James G Chandler; Sanchayita Mitra; Arsen Ghasabyan; Theresa L Chin; Angela Sauaia; Anirban Banerjee; Christopher C Silliman Journal: J Trauma Acute Care Surg Date: 2016-01 Impact factor: 3.313
Authors: Florian Roquet; Arthur Neuschwander; Sophie Hamada; Gersende Favé; Arnaud Follin; David Marrache; Bernard Cholley; Romain Pirracchio Journal: JAMA Netw Open Date: 2019-09-04