Abnormalities of laboratory coagulation tests versus clinically evident coagulopathic bleeding: results from the prehospital resuscitation on helicopters study (PROHS)

Ronald Chang, Erin E Fox, Thomas J Greene, Michael D Swartz, Stacia M DeSantis, Deborah M Stein, Eileen M Bulger, Sherry M Melton, Michael D Goodman, Martin A Schreiber, Martin D Zielinski, Terence O'Keeffe, Kenji Inaba, Jeffrey S Tomasek, Jeanette M Podbielski, Savitri Appana, Misung Yi, Pär I Johansson, Hanne H Henriksen, Jakob StensballeJacob Steinmetz, Charles E Wade, John B Holcomb, PROHS Study Group

21 Citationer (Scopus)

Abstract

BACKGROUND: Laboratory-based evidence of coagulopathy (LC) is observed in 25-35% of trauma patients, but clinically-evident coagulopathy (CC) is not well described.

METHODS: Prospective observational study of adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers in 2015. Patients meeting predefined highest-risk criteria were divided into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC-. We used a mixed-effects, Poisson regression with robust error variance to test the hypothesis that abnormalities on rapid thrombelastography (r-TEG) and international normalized ratio (INR) were independently associated with CC+.

RESULTS: Of 1,019 highest-risk patients, CC+ (n=41, 4%) were more severely injured (median ISS 32 vs 17), had evidence of LC on r-TEG and INR, received more transfused blood products at 4 hours (37 vs 0 units), and had greater 30-day mortality (59% vs 12%) than CC- (n=978, 96%). The overall incidence of LC was 39%. 30-day mortality was 22% vs 9% in those with and without LC. In two separate models, r-TEG K-time >2.5 min (RR 1.3, 95% CI 1.1-1.7), r-TEG mA <55 mm (RR 2.5, 95% CI 2.0-3.2), platelet count <150 x 109/L (RR 1.2, 95% CI 1.1-1.3), and INR >1.5 (RR 5.4, 95% CI 1.8-16.3) were independently associated with CC+. A combined regression model was not generated because too few patients underwent both r-TEG and INR.

CONCLUSION: CC was rare compared to LC. CC was associated with poor outcomes and impairment of both clotting factor and platelet-mediated coagulation components. (Surgery 2017;160:XXX-XXX.).

OriginalsprogEngelsk
TidsskriftSurgery
Sider (fra-til)819-826
Antal sider8
ISSN0039-6060
DOI
StatusUdgivet - 2018

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