TY - JOUR
T1 - Abnormalities of laboratory coagulation tests versus clinically evident coagulopathic bleeding
T2 - results from the prehospital resuscitation on helicopters study (PROHS)
AU - PROHS Study Group
AU - Chang, Ronald
AU - Fox, Erin E.
AU - Greene, Thomas J.
AU - Swartz, Michael D.
AU - DeSantis, Stacia M.
AU - Stein, Deborah M.
AU - Bulger, Eileen M.
AU - Melton, Sherry M.
AU - Goodman, Michael D.
AU - Schreiber, Martin A.
AU - Zielinski, Martin D.
AU - O'Keeffe, Terence
AU - OKeeffe, Terence
AU - Tomasek, Jeffrey S.
AU - Podbielski, Jeanette M.
AU - Appana, Savitri
AU - Yi, Misung
AU - Johansson, Pär I.
AU - Henriksen, Hanne H.
AU - Stensballe, Jakob
AU - Steinmetz, Jacob
AU - Wade, Charles E.
AU - Holcomb, John B.
AU - Holcomb, John B.
AU - Wade, Charles E.
AU - Fox, Erin E.
AU - Chang, Ronald
AU - Podbielski, Jeanette M.
AU - Tomasek, Jeffrey S.
AU - del Junco, Deborah J.
AU - Swartz, Michael D.
AU - DeSantis, Stacia M.
AU - Appana, Savitri N.
AU - Greene, Thomas J.
AU - Yi, Misung
AU - Gonzalez, Michael O.
AU - Baraniuk, Sarah
AU - van Belle, Gerald
AU - Leroux, Brian G.
AU - Howard, Carrie L.
AU - Haymaker, Amanda
AU - Stein, Deborah M.
AU - Scalea, Thomas M.
AU - Ayd, Benjamin
AU - Das, Pratik
AU - Herrera, Anthony V.
AU - Bulger, Eileen M.
AU - Robinson, Bryce R.H.
AU - Klotz, Patricia
AU - Minhas, Aniqa
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - 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.
AB - 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.
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U2 - 10.1016/j.surg.2017.10.050
DO - 10.1016/j.surg.2017.10.050
M3 - Article
C2 - 29289392
AN - SCOPUS:85039165623
SN - 0039-6060
VL - 163
SP - 819
EP - 826
JO - Surgery (United States)
JF - Surgery (United States)
IS - 4
ER -