Jean-Stéphane David1,2, Arnaud Friggeri3, Charles-Hervé Vacheron3, Pierre Bouzat4, Laurie Fraticelli5,6, Clément Claustre5,6, Marc Maegele7, Kenji Inaba8. 1. Department d'Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. js-david@univ-lyon1.fr. 2. Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France. js-david@univ-lyon1.fr. 3. Department d'Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France. 4. Department of Anesthesia and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, 38000, Grenoble, France. 5. RESUVAL Trauma Network, Lucien Hussel General Hospital, Vienne, France. 6. EA 4129 P2S Parcours Santé Systémique, University Claude Bernard Lyon 1, 69008, Lyon, France. 7. Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, 200, 51109, Cologne, Germany. 8. Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA.
Abstract
PURPOSE: It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PTratio threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PTratio (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis. METHODS: Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PTratio or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PTratio and ROTEM parameter subclasses with mortality. RESULTS: Three thresholds were, respectively, identified for PTratio (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PTratio: ≤ 1.20 (No TIC), 1.21-1.90 (Moderate TIC), 1.91-3.00 (severe TIC), > 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91-130 s (moderate TIC), 131-200 s (severe TIC) and > 200 s (major TIC). We observed that when the PTratio (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PTratio and EXTEM-CT was independently associated with mortality at 24-h. CONCLUSION: In this study, we have described a pragmatic classification of coagulopathy utilizing PTratio and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products.
PURPOSE: It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PTratio threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PTratio (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis. METHODS: Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PTratio or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PTratio and ROTEM parameter subclasses with mortality. RESULTS: Three thresholds were, respectively, identified for PTratio (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PTratio: ≤ 1.20 (No TIC), 1.21-1.90 (Moderate TIC), 1.91-3.00 (severe TIC), > 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91-130 s (moderate TIC), 131-200 s (severe TIC) and > 200 s (major TIC). We observed that when the PTratio (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PTratio and EXTEM-CT was independently associated with mortality at 24-h. CONCLUSION: In this study, we have described a pragmatic classification of coagulopathy utilizing PTratio and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products.
Authors: Harald Leemann; Thomas Lustenberger; Peep Talving; Leslie Kobayashi; Marko Bukur; Mirko Brenni; Martin Brüesch; Donat R Spahn; Marius J B Keel Journal: J Trauma Date: 2010-12