Spectrum of coagulation profiles in severely injured patients - a subgroup analysis from the fluids in resuscitation of severe trauma trial.

Humans Blood Coagulation Disorders / etiology Injury Severity Score Retrospective Studies Thrombelastography Wounds and Injuries / complications Wounds, Penetrating Randomized Controlled Trials as Topic

Journal

South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie
ISSN: 2078-5151
Titre abrégé: S Afr J Surg
Pays: South Africa
ID NLM: 2984854R

Informations de publication

Date de publication:
Mar 2023
Historique:
medline: 14 4 2023
entrez: 13 4 2023
pubmed: 14 4 2023
Statut: ppublish

Résumé

Trauma-induced coagulopathy (TIC) is a major contributing factor to worsening bleeding in trauma patients. The objective of this study is to describe the spectrum of coagulation profiles amongst severely injured patients. This is a retrospective study of all patients with complete baseline TEG coagulation parameters collected prior to randomisation in the FIRST (fluids in resuscitation of severe trauma) trial between January 2007 and December 2009. Parameters recorded for this study included patient demographics, mechanism of injury, admission vital signs, lactate, base excess, coagulation studies prothrombin time (PT), international normalised ratio (INR), thromboelastography (TEG) parameters, volume, and type of fluids administered, volume of blood products administered, length of intensive care unit (ICU) stay and major outcomes. A total of 87 patients were included in this study, with a median injury severity score (ISS) of 20 and 57.5 had a penetrating injury mechanism. Coagulopathy was highly prevalent in this cohort, of which a majority (69%) was diagnosed with hypercoagulopathy and 24% had a hypocoagulopathy status on admission. There was no difference in age, gender and amount of pre-hospital fluids administered across the three groups. The median volume of blood products was higher in the hypocoagulopathy group, although not statistically significant. Overall, the 30-day mortality rate was 13%, with case fatalities occurring in only coagulopathic patients: hypercoagulopathy (15%) and hypocoagulopathy (10%). TIC is not an infrequent diagnosis in severely injured patients resulting in increased morbidity and mortality. Determining the coagulation profile using TEG at presentation in this group of patients may inform appropriate management guidelines in order to improve outcome.

Sections du résumé

BACKGROUND BACKGROUND
Trauma-induced coagulopathy (TIC) is a major contributing factor to worsening bleeding in trauma patients. The objective of this study is to describe the spectrum of coagulation profiles amongst severely injured patients.
METHODS METHODS
This is a retrospective study of all patients with complete baseline TEG coagulation parameters collected prior to randomisation in the FIRST (fluids in resuscitation of severe trauma) trial between January 2007 and December 2009. Parameters recorded for this study included patient demographics, mechanism of injury, admission vital signs, lactate, base excess, coagulation studies prothrombin time (PT), international normalised ratio (INR), thromboelastography (TEG) parameters, volume, and type of fluids administered, volume of blood products administered, length of intensive care unit (ICU) stay and major outcomes.
RESULTS RESULTS
A total of 87 patients were included in this study, with a median injury severity score (ISS) of 20 and 57.5 had a penetrating injury mechanism. Coagulopathy was highly prevalent in this cohort, of which a majority (69%) was diagnosed with hypercoagulopathy and 24% had a hypocoagulopathy status on admission. There was no difference in age, gender and amount of pre-hospital fluids administered across the three groups. The median volume of blood products was higher in the hypocoagulopathy group, although not statistically significant. Overall, the 30-day mortality rate was 13%, with case fatalities occurring in only coagulopathic patients: hypercoagulopathy (15%) and hypocoagulopathy (10%).
CONCLUSION CONCLUSIONS
TIC is not an infrequent diagnosis in severely injured patients resulting in increased morbidity and mortality. Determining the coagulation profile using TEG at presentation in this group of patients may inform appropriate management guidelines in order to improve outcome.

Identifiants

PMID: 37052275
pubmed: 37052275

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

21-26

Informations de copyright

Copyright© Authors.

Auteurs

M E H Nathire (MEH)

Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa.

M F M James (MFM)

Department of Anaesthesia, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa.

S Sobnach (S)

Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa.

A Nicol (A)

Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa.

P H Navsaria (PH)

Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, South Africa.

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Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Hémopathies et maladies lymphatiques › Hémopathies › Troubles de l'hémostase et de la coagulation › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Score de gravité des lésions traumatiques › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Techniques d'investigation › Techniques de laboratoire clinique › Tests hématologiques › Tests de coagulation sanguine › Thromboélastographie › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Plaies et blessures › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Plaies et blessures › Plaies pénétrantes › Spectrum of coagulation profiles in severely...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Spectrum of coagulation profiles in severely...