Tags

Type your tag names separated by a space and hit enter

Increased mortality associated with the early coagulopathy of trauma in combat casualties.
J Trauma. 2008 Jun; 64(6):1459-63; discussion 1463-5.JT

Abstract

BACKGROUND

Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio >/=1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian trauma patients.

METHODS

A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality.

RESULTS

A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6).

CONCLUSIONS

The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian trauma patients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian trauma patients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes.

Authors+Show Affiliations

USA MEDDAC Bavaria (S.E.N.), Vilseck, Germany. sarah.niles@amedd.army.milNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18545109

Citation

Niles, Sarah E., et al. "Increased Mortality Associated With the Early Coagulopathy of Trauma in Combat Casualties." The Journal of Trauma, vol. 64, no. 6, 2008, pp. 1459-63; discussion 1463-5.
Niles SE, McLaughlin DF, Perkins JG, et al. Increased mortality associated with the early coagulopathy of trauma in combat casualties. J Trauma. 2008;64(6):1459-63; discussion 1463-5.
Niles, S. E., McLaughlin, D. F., Perkins, J. G., Wade, C. E., Li, Y., Spinella, P. C., & Holcomb, J. B. (2008). Increased mortality associated with the early coagulopathy of trauma in combat casualties. The Journal of Trauma, 64(6), 1459-63; discussion 1463-5. https://doi.org/10.1097/TA.0b013e318174e8bc
Niles SE, et al. Increased Mortality Associated With the Early Coagulopathy of Trauma in Combat Casualties. J Trauma. 2008;64(6):1459-63; discussion 1463-5. PubMed PMID: 18545109.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increased mortality associated with the early coagulopathy of trauma in combat casualties. AU - Niles,Sarah E, AU - McLaughlin,Daniel F, AU - Perkins,Jeremy G, AU - Wade,Charles E, AU - Li,Yuanzhang, AU - Spinella,Philip C, AU - Holcomb,John B, PY - 2008/6/12/pubmed PY - 2008/7/17/medline PY - 2008/6/12/entrez SP - 1459-63; discussion 1463-5 JF - The Journal of trauma JO - J Trauma VL - 64 IS - 6 N2 - BACKGROUND: Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio >/=1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian trauma patients. METHODS: A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality. RESULTS: A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6). CONCLUSIONS: The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian trauma patients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian trauma patients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/18545109/Increased_mortality_associated_with_the_early_coagulopathy_of_trauma_in_combat_casualties_ L2 - https://doi.org/10.1097/TA.0b013e318174e8bc DB - PRIME DP - Unbound Medicine ER -