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Early coagulopathy in trauma patients: An on-scene and hospital admission study.
MedLine Citation:
PMID:  21112053     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: Amongst trauma patients, early coagulopathy is common on hospital admission. No studies have evaluated the initial coagulation status in the pre-hospital setting. We hypothesise that the coagulopathic process begins at the time of trauma. We studied the on-scene and on hospital arrival coagulation profile of trauma patients. METHODS: Prospective, observational study investigating the on-scene coagulation profile and its time course. We studied 45 patients at the scene of the accident, before fluid administration, and on hospital admission and classified their coagulopathy using the International Society on Thrombosis and Haemostasis score during a 2-month period. Prothrombin time, activated partial thromboplastin time, fibrinogen concentration, factors II, V and VII activity, fibrin degradation products, antithrombin and protein C activities, platelet counts and base deficit were measured. RESULTS: The median injury severity score was 25 (13-35). On-scene, coagulation status was abnormal in 56% of patients. Protein C activities were decreased in the trauma-associated coagulopathy group (p=.02). Drops in protein C activities were associated with changes in activated partial thromboplastin time, prothrombin time, fibrinogen concentration, factor V and antithrombin activities. Only factor V levels decreased significantly with the severity of the trauma. On hospital admission, coagulation status was abnormal in 60% of patients. The on-scene coagulopathy was spontaneously normalised only in 2 patients whereas others had the same or a poorer coagulopathy status. All parameters of coagulation were significantly abnormal comparing to the on-scene phase. Decreases in protein C activities were related to the coagulation status (p<.0001) and changes in other coagulation parameters. Patients with base deficit ≤-6mmol/L had changes in antithrombin, factor V and protein C activities but no significant coagulopathy. CONCLUSION: Coagulopathy occurs very early after injury, before fluid administration, at the site of accident. Coagulation and fibrinolytic systems are activated early. The incidence of coagulopathy is high and its severity is related to the injury and not to hypoperfusion.
Authors:
Bernard Floccard; Lucia Rugeri; Alexandre Faure; Marc Saint Denis; Eileen Mary Boyle; Olivier Peguet; Albrice Levrat; Christian Guillaume; Guillaume Marcotte; Alexandre Vulliez; Etienne Hautin; Jean Stéphane David; Claude Négrier; Bernard Allaouchiche
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-11-25
Journal Detail:
Title:  Injury     Volume:  -     ISSN:  1879-0267     ISO Abbreviation:  Injury     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2010 Elsevier Ltd. All rights reserved.
Affiliation:
Département d'Anesthésie-Réanimation, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France.
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