Document Detail


Functional definition and characterization of acute traumatic coagulopathy.
MedLine Citation:
PMID:  21765358     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage.
DESIGN: Prospective observational cohort study.
SETTING: Level 1 trauma center.
PATIENTS: Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital.
INTERVENTIONS: None.
MEASUREMENTS: Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission.
MAIN RESULTS: Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% false-negative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of ≤35 mm had a detection rate of 77% for acute traumatic coagulopathy with a false-positive rate of 13%. Patients with clot amplitude at 5 mins ≤35 mm were more likely to receive red cell (46% vs. 17%, p < .001) and plasma (37% vs. 11%, p < .001) transfusions. The clot amplitude at 5 mins could identify patients who would require massive transfusion (detection rate of 71%, vs. 43% for prothrombin time ratio >1.2, p < .001).
CONCLUSIONS: In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of ≤35 mm, rotational thromboelastometry can identify acute traumatic coagulopathy at 5 mins and predict the need for massive transfusion.
Authors:
Ross Davenport; Joanna Manson; Henry De'Ath; Sean Platton; Amy Coates; Shubha Allard; Daniel Hart; Rupert Pearse; K John Pasi; Peter MacCallum; Simon Stanworth; Karim Brohi
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2011-11-18     Completed Date:  2012-01-13     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2652-8     Citation Subset:  AIM; IM    
Affiliation:
Trauma Sciences, Blizard Institute of Cell and Molecular Science, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Blood Coagulation
Blood Coagulation Disorders / diagnosis,  etiology*
Blood Coagulation Tests
Female
Hemorrhage / blood,  complications
Humans
Male
Middle Aged
Prospective Studies
Prothrombin Time
Wounds and Injuries / blood,  complications*
Young Adult
Grant Support
ID/Acronym/Agency:
RP-PG-0407-10036//Department of Health
Comments/Corrections

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