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Mechanism of injury affects acute coagulopathy of trauma in combat casualties.
J Trauma. 2011 Jul; 71(1 Suppl):S74-7.JT

Abstract

BACKGROUND

Recent evidence suggests trauma involving total body tissue damage increases the acute coagulopathy of trauma (ACOT) by various mechanisms, especially in massive transfusion (MT). Our hypothesis was that MT patients injured by explosion will have a higher international normalization ratio (INR) at admission than MT patients injured by gunshot wound (GSW).

METHODS

A retrospective review was performed on US military injured in Operation Iraqi Freedom/Operation Enduring Freedom from March 2003 to September 2008, who received MT (≥ 10 red blood cells in 24 hours) and had an INR on admission. Two cohorts were created based on mechanism. Admission vital signs, labs, transfusion, and mortality data were compared.

RESULTS

Seven hundred fifty-one MT patients were identified. Four hundred fifty patients had admission INR and were injured by either GSW or explosion. Patients demonstrated similar injury severity scale and Glasgow Coma Scale. Patients injured by explosion presented with higher INR, greater base deficit, and more tachycardic than patients injured by GSW. Transfusion of blood products was similar between both groups.

CONCLUSIONS

The primary finding of this study is that patients injured by explosion presented with a higher INR than those injured by GSW, even with similar injury severity scale. In addition, patients injured by explosion presented more tachycardic and with a greater base deficit. These findings support the theory that ACOT is affected by the amount of tissue injured. Further research is needed into the pathophysiology of ACOT because this may impact care of patients with total body tissue damage/hypoxia and improve the treatment of their coagulopathy while minimizing the attendant complications.

Authors+Show Affiliations

United States Army Institute of Surgical Research, San Antonio, Texas 78234, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21795881

Citation

Simmons, John W., et al. "Mechanism of Injury Affects Acute Coagulopathy of Trauma in Combat Casualties." The Journal of Trauma, vol. 71, no. 1 Suppl, 2011, pp. S74-7.
Simmons JW, White CE, Ritchie JD, et al. Mechanism of injury affects acute coagulopathy of trauma in combat casualties. J Trauma. 2011;71(1 Suppl):S74-7.
Simmons, J. W., White, C. E., Ritchie, J. D., Hardin, M. O., Dubick, M. A., & Blackbourne, L. H. (2011). Mechanism of injury affects acute coagulopathy of trauma in combat casualties. The Journal of Trauma, 71(1 Suppl), S74-7. https://doi.org/10.1097/TA.0b013e3182218cc1
Simmons JW, et al. Mechanism of Injury Affects Acute Coagulopathy of Trauma in Combat Casualties. J Trauma. 2011;71(1 Suppl):S74-7. PubMed PMID: 21795881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanism of injury affects acute coagulopathy of trauma in combat casualties. AU - Simmons,John W, AU - White,Christopher E, AU - Ritchie,John D, AU - Hardin,Mark O, AU - Dubick,Michael A, AU - Blackbourne,Lorne H, PY - 2011/7/29/entrez PY - 2011/8/4/pubmed PY - 2011/10/13/medline SP - S74 EP - 7 JF - The Journal of trauma JO - J Trauma VL - 71 IS - 1 Suppl N2 - BACKGROUND: Recent evidence suggests trauma involving total body tissue damage increases the acute coagulopathy of trauma (ACOT) by various mechanisms, especially in massive transfusion (MT). Our hypothesis was that MT patients injured by explosion will have a higher international normalization ratio (INR) at admission than MT patients injured by gunshot wound (GSW). METHODS: A retrospective review was performed on US military injured in Operation Iraqi Freedom/Operation Enduring Freedom from March 2003 to September 2008, who received MT (≥ 10 red blood cells in 24 hours) and had an INR on admission. Two cohorts were created based on mechanism. Admission vital signs, labs, transfusion, and mortality data were compared. RESULTS: Seven hundred fifty-one MT patients were identified. Four hundred fifty patients had admission INR and were injured by either GSW or explosion. Patients demonstrated similar injury severity scale and Glasgow Coma Scale. Patients injured by explosion presented with higher INR, greater base deficit, and more tachycardic than patients injured by GSW. Transfusion of blood products was similar between both groups. CONCLUSIONS: The primary finding of this study is that patients injured by explosion presented with a higher INR than those injured by GSW, even with similar injury severity scale. In addition, patients injured by explosion presented more tachycardic and with a greater base deficit. These findings support the theory that ACOT is affected by the amount of tissue injured. Further research is needed into the pathophysiology of ACOT because this may impact care of patients with total body tissue damage/hypoxia and improve the treatment of their coagulopathy while minimizing the attendant complications. SN - 1529-8809 UR - https://www.unboundmedicine.com/medline/citation/21795881/Mechanism_of_injury_affects_acute_coagulopathy_of_trauma_in_combat_casualties_ L2 - https://doi.org/10.1097/TA.0b013e3182218cc1 DB - PRIME DP - Unbound Medicine ER -