C. E. Nembhard1, J. Hwabejire1, E. Cornwell1, W. Greene1 1Howard University College Of Medicine,General Surgery,Washington, DC, USA
Introduction:
Trauma-induced coagulopathy causes uncontrollable hemorrhage and is associated with high mortality. Blood component replacement is the main treatment. However the relationship between platelet level and outcomes is not clearly defined. This study investigates the risk factors and predictors of mortality in trauma-induced coagulopathy.
Methods:
The Glue Grant database was examined including adults ≥ 18 yrs who sustained blunt traumatic hemorrhagic shock. They were divided into two groups: trauma-induced coagulopathy [Coag; defined as an international normalized ratio (INR)> 1.5 in the emergency room (ER) in the absence of pre-existing coagulopathy or current anticoagulation medication] and no coagulopathy (NoCoag) on presentation. The groups were compared using univariate analysis and multivariate analysis identified the predictors of trauma coagulopathy and mortality.
Results:
1804 patients met the inclusion criteria, 66.2% male. 21.9% (n= 395) had trauma-induced coagulopathy. Significant differences between Coag vs. NoCoag group include: Age, yrs (40±20 vs. 44±18, p<0.001),Injury Severity Score, ISS (37±14 vs.31±13 p<0.001), pre-hospital blood transfusion, mL (344±1076 vs. 185±551, p<0.001), pre-hospital crystalloid, mL (3217±2616 vs. 1844±1959), ER systolic blood pressure(109±34 vs.112±30 p=0.038), ER lactate (5.7±3.5vs. 4.2±2.5p<0.001), ER initial hemoglobin (9.6±2.8 vs.11.9±2.3 p<0.001), resuscitation fresh frozen plasma (1454±1373 vs. 525±924 p<0.001) , platelet (230±341 vs. 104±320), total blood transfused in 12 hours (4097±4033 vs.2281 ±2759<0.001), ICU days (14±12 vs. 13±12), acute respiratory distress syndrome,ARDS (31.9% vs. 22.6% p<0.001) and pulmonary embolism(5.8 vs. 3.2% p=0.015). Predictors of Coag include ISS (OR1.021 CI1.009-1.032 p<0.001), ER lactate (OR1.12 CI1.060-1.184 p<0.001). Overall mortality was 15.5%, 27.3% in the Coag group and 12% in the NoCoag group. Predictors of mortality in Coag patients were: maximum lactate in 12-24hours (OR1.32 CI1.05-1.66 p=0.017), ARDS (OR 5.63 CI2.09-15.20 p<0.001) and cardiac arrest (OR84.7 CI13.46-532.95 p<0.001). Protective against mortality were: platelet count (OR0.97 CI0.95-0.99 p=0.002) and ICU days (OR0.88 CI0.83-0.94 p<0.001). Table 1. shows the relationship between platelet count and mortality.
Conclusion:
Conclusion: In patients with coagulopathy due to blunt trauma mortality is high. Platelet count is inversely proportional to mortality. Mortality can be decreased to less than that of patients without coagulopathy if the platelet count is kept above 150.
