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Effect of emergency department fibrinogen testing on survival of trauma patients receiving blood transfusions.
Blood Coagul Fibrinolysis. 2020 Jun 30 [Online ahead of print]BC

Abstract

: Fibrinogen is the first clotting factor to reach critically low levels during blood loss and its depletion is associated with coagulopathy, increased blood loss, transfusion requirements and mortality after trauma. However, direct measurements of fibrinogen concentration or function are not included in many Emergency Department (ED) trauma laboratory testing protocols. We hypothesized that including a test of fibrinogen concentration in the ED would be associated with increased survival for trauma patients requiring blood transfusions.To test this hypothesis, we performed a single-centre retrospective study of the effect of a resulted fibrinogen concentration measurement performed in the ED on survival of trauma patients receiving blood transfusions within the first 4 h of their hospital arrival. Multivariate logistic regression was used test the effect of a fibrinogen test on hospital survival after adjusting for the influence of INR, injury severity, lowest recorded blood pressure and blood transfusion intensity defined as the number of red blood cell units transfused in the first 4 h or care.Of 11 404 trauma registry individuals from 2016 to 2017, 843 (7.4%) received any blood transfusions within the first 4 h of ED care, of whom 635 (75.3%) had a documented fibrinogen concentration ordered and resulted. Multivariate logistic regression for hospital survival demonstrated a significant interaction effect between the presence of a fibrinogen test and transfusion intensity (Whole Model P < 0.0001, Interaction P = 0.035). Repeat analysis after stratifying for those individuals receiving more than 4 units of red blood cell units within 4 h of care found that the presence of a fibrinogen test was independently associated with survival only for those receiving more than 4 units [FIB test odds ratio for survival = 3.5 (1.0, 10.8), P = 0.03].Fibrinogen testing in the ED may be a valuable addition to resuscitation of the trauma patient receiving significant blood transfusions.

Authors+Show Affiliations

Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington.Idaho College of Osteopathic Medicine, Meridian, Idaho.Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, Washington, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32618590

Citation

White, Nathan J., et al. "Effect of Emergency Department Fibrinogen Testing On Survival of Trauma Patients Receiving Blood Transfusions." Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis, 2020.
White NJ, Chien D, Hess JR. Effect of emergency department fibrinogen testing on survival of trauma patients receiving blood transfusions. Blood Coagul Fibrinolysis. 2020.
White, N. J., Chien, D., & Hess, J. R. (2020). Effect of emergency department fibrinogen testing on survival of trauma patients receiving blood transfusions. Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis. https://doi.org/10.1097/MBC.0000000000000924
White NJ, Chien D, Hess JR. Effect of Emergency Department Fibrinogen Testing On Survival of Trauma Patients Receiving Blood Transfusions. Blood Coagul Fibrinolysis. 2020 Jun 30; PubMed PMID: 32618590.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of emergency department fibrinogen testing on survival of trauma patients receiving blood transfusions. AU - White,Nathan J, AU - Chien,Diana, AU - Hess,John R, Y1 - 2020/06/30/ PY - 2020/7/4/entrez PY - 2020/7/4/pubmed PY - 2020/7/4/medline JF - Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis JO - Blood Coagul. Fibrinolysis N2 - : Fibrinogen is the first clotting factor to reach critically low levels during blood loss and its depletion is associated with coagulopathy, increased blood loss, transfusion requirements and mortality after trauma. However, direct measurements of fibrinogen concentration or function are not included in many Emergency Department (ED) trauma laboratory testing protocols. We hypothesized that including a test of fibrinogen concentration in the ED would be associated with increased survival for trauma patients requiring blood transfusions.To test this hypothesis, we performed a single-centre retrospective study of the effect of a resulted fibrinogen concentration measurement performed in the ED on survival of trauma patients receiving blood transfusions within the first 4 h of their hospital arrival. Multivariate logistic regression was used test the effect of a fibrinogen test on hospital survival after adjusting for the influence of INR, injury severity, lowest recorded blood pressure and blood transfusion intensity defined as the number of red blood cell units transfused in the first 4 h or care.Of 11 404 trauma registry individuals from 2016 to 2017, 843 (7.4%) received any blood transfusions within the first 4 h of ED care, of whom 635 (75.3%) had a documented fibrinogen concentration ordered and resulted. Multivariate logistic regression for hospital survival demonstrated a significant interaction effect between the presence of a fibrinogen test and transfusion intensity (Whole Model P < 0.0001, Interaction P = 0.035). Repeat analysis after stratifying for those individuals receiving more than 4 units of red blood cell units within 4 h of care found that the presence of a fibrinogen test was independently associated with survival only for those receiving more than 4 units [FIB test odds ratio for survival = 3.5 (1.0, 10.8), P = 0.03].Fibrinogen testing in the ED may be a valuable addition to resuscitation of the trauma patient receiving significant blood transfusions. SN - 1473-5733 UR - https://www.unboundmedicine.com/medline/citation/32618590/Effect_of_emergency_department_fibrinogen_testing_on_survival_of_trauma_patients_receiving_blood_transfusions L2 - https://doi.org/10.1097/MBC.0000000000000924 DB - PRIME DP - Unbound Medicine ER -
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