Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

The Effect of Acute Coagulopathy in Profoundly Traumatic Patients on Acute and Early Deaths

고도 중증외상 환자에서 급성 혈액응고장애가 초기 및 조기 사망에 미치는 영향

  • Noh, Minsu (Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Yang, Song-Soo (Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine) ;
  • Kyoung, Kyu-Hyouck (Department of Trauma Center, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 노민수 (울산대학교 의과대학 울산대학교병원 외과학교실) ;
  • 양성수 (울산대학교 의과대학 울산대학교병원 외과학교실) ;
  • 경규혁 (울산대학교 의과대학 울산대학교병원 권역외상센터)
  • Received : 2014.09.14
  • Accepted : 2014.10.22
  • Published : 2014.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Numerous studies have investigated the pattern of traumatic death with a focus on the injury mechanism, the severity of the injury and the presence of hemorrhage. Acute coagulopathy has been treated as only one of many complications. The purpose of this study was to investigate the influence of acute coagulopathy on acute and early death due to trauma. Methods: A retrospective analysis of trauma patients with injury severity score (ISS)${\geq}25$ who had been treated between January 2011 and December 2012 was conducted. Based on the time of injury, traumatic death was categorized into acute (within 48 hours) and early (from 3 to 7 days). The correlations between various parameters within 24 hours after injury and time of death were analyzed. Results: A total of 124 patients were enrolled. Of them, 8.1% (n=10) of the patients experienced acute mortality. For those patients, significant differences in initial systolic blood pressure, coagulopathy score, amount of transfusion, abbreviated injury scale of the head and neck, the abdomen and the extremities were noted. Early mortality was experienced by 7.0% (n=8) of the patients, only coagulopathy score was found to be a significant independent risk factor for acute (odds ratio: 3.127; 95% confidence interval: 1.185-8.252; p=0.021) and early mortality (odds ratio: 2.470; 95% confidence interval: 1.029-5.929; p=0.043). Conclusion: Acute traumatic coagulopathy has an important role in the mortality, even after the acute phase. Early management and prevention of acute coagulopathy may improve survival of trauma patients.

Keywords

References

  1. World Health Organization (2001) The world health report 2001: mental health: new understanding, new hope. Geneva, World Health Organization. http://www.who.int/whr/2001/en/ whr01_en. pdf Accessed 22 Dec 2013.
  2. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg 1980; 140: 144-50. https://doi.org/10.1016/0002-9610(80)90431-6
  3. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 1983: 249: 28-35. https://doi.org/10.1038/scientificamerican0883-28
  4. Gunst M, Ghaemmaghami V, Gruszecki A, Urban J, Frankel H, Shafi S. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc (BaylUniv Med Cent) 2010; 23: 349-54.
  5. Clark DE, Qian J, Sihler KC, Hallagan LD, Betensky RA. The distribution of survival times after injury. World J Surg 2012; 36: 1562-70. https://doi.org/10.1007/s00268-012-1549-5
  6. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, et al. Epidemiology of trauma deaths: a reassessment. J Trauma 1995; 38: 185-93. https://doi.org/10.1097/00005373-199502000-00006
  7. Pang JM, Civil I, Ng A, Adams D, Koelmeyer T. Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004. Injury 2008;39: 102-6. https://doi.org/10.1016/j.injury.2007.05.022
  8. Acosta JA, Yang JC, Winchell RJ, Simons RK, Fortlage DA, Hollingsworth-Fridlund P, et al. Lethal injuries and time to death in a level I trauma center. J Am CollSurg 1998; 186: 528-33.
  9. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003; 54: 1127-30. https://doi.org/10.1097/01.TA.0000069184.82147.06
  10. MacLeod JB, Winkler AM, McCoy CC, Hillyer CD, Shaz BH. Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum. Injury 2014; 45: 910-5. https://doi.org/10.1016/j.injury.2013.11.004
  11. Niles SE, McLaughlin DF, Perkins JG, Wade CE, Li Y, Spinella PC, et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma 2008; 64: 1459-65. https://doi.org/10.1097/TA.0b013e318174e8bc
  12. Mitra B, Cameron PA, Mori A, Fitzgerald M. Acute coagulopathy and early deaths post major trauma. Injury 2012; 43: 22-5. https://doi.org/10.1016/j.injury.2010.10.015
  13. Angstwurm MW, Dempfle CE, Spannagl M. New disseminated intravascular coagulation score: A useful tool to predict mortality in comparison with Acute Physiology and Chronic Health Evaluation II and Logistic Organ Dysfunction scores.Crit Care Med 2006; 34: 314-2. https://doi.org/10.1097/01.CCM.0000196832.27501.B2
  14. Evans JA, van Wessem KJ, McDougall D, Lee KA, Lyons T, Balogh ZJ. Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 2010; 34: 158-63. https://doi.org/10.1007/s00268-009-0266-1
  15. Abdelrahman H, El-Menyar A, Al-Thani H, Consunji R, Zarour A, Peralta R, et al. Time-Based Trauma-Related Mortality Patterns in a Newly Created Trauma System. World J Surg 2014; 38: 2804-12. https://doi.org/10.1007/s00268-014-2705-x
  16. Maier B, Lefering R, Lehnert M, Laurer HL, Steudel WI, Neugebauer EA, et al. Early versus late onset of multiple organ failure is associated with differing patterns of plasma cytokine biomarker expression and outcome after severe trauma. Shock 2007; 28: 668-74.
  17. Cohen MJ, Call M, Nelson M, Calfee CS, Esmon CT, Brohi K, et al. Critical role of activated protein C in early coagulopathy and later organ failure, infection and death in trauma patients. Ann Surg 2012; 255: 379-85. https://doi.org/10.1097/SLA.0b013e318235d9e6
  18. Brohi K, Cohen MJ, Ganter MT, Matthay MA, Mackersie RC, Pittet JF. Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg 2007; 245: 812-8. https://doi.org/10.1097/01.sla.0000256862.79374.31
  19. Deras P, Villiet M, Manzanera J, Latry P, Schved JF, Capdevila X, et al. Early coagulopathy at hospital admission predicts initial or delayed fibrinogen deficit in severe trauma patients. J Trauma Acute Care Surg 2014; 77: 433-40. https://doi.org/10.1097/TA.0000000000000314
  20. Dong Eun Lee, Kang Suk Seo, MiJin Lee, Su Jeong Shin, Hyun WookRyoo, Jong Kun Kim, et al. Acute Traumatic Coagulopathy in Severe Trauma Patients. J Trauma Inj 2012; 25: 72-8.
  21. Gonzalez EA, Moore FA, Holcomb JB, Miller CC, Kozar RA, Todd SR, et al. Fresh frozen plasma should be given earlier to patients requiring massive transfusion. J Trauma 2007; 62: 112-9. https://doi.org/10.1097/01.ta.0000250497.08101.8b
  22. Zink KA, Sambasivan CN, Holcomb JB, Chisholm G, Schreiber MA. A high ratio of plasma and platelets to packed red blood cells in the first 6 hours of massive transfusion improves outcomes in a large multicenter study. Am J Surg 2009; 197: 565-70. https://doi.org/10.1016/j.amjsurg.2008.12.014
  23. Pfeifer R, Tarkin IS, Rocos B, Pape HC. Patterns of mortality and causes of death in polytrauma patients--has anything changed? Injury 2009; 40: 907-11. https://doi.org/10.1016/j.injury.2009.05.006