Early coagulopathy in trauma patients: An on-scene and hospital admission study
| Autor: | Eileen M Boyle, Etienne Hautin, Christian Guillaume, Lucia Rugeri, Marc Saint Denis, Albrice Levrat, Alexandre Vulliez, Bernard Allaouchiche, Bernard Floccard, Jean Stephane David, Claude Negrier, Alexandre Faure, Olivier Peguet, Guillaume Marcotte |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Emergency Medical Services medicine.medical_specialty Time Factors Fibrinogen Injury Severity Score Patient Admission Trauma Centers Predictive Value of Tests Coagulopathy Humans Medicine Prospective Studies General Environmental Science Disseminated intravascular coagulation Prothrombin time biology medicine.diagnostic_test business.industry Incidence Antithrombin Factor V Blood Coagulation Disorders Middle Aged medicine.disease Surgery Anesthesia Prothrombin Time biology.protein Wounds and Injuries General Earth and Planetary Sciences Female Partial Thromboplastin Time business Biomarkers Protein C medicine.drug Partial thromboplastin time |
| Zdroj: | Injury. 43:26-32 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2010.11.003 |
| Popis: | Amongst trauma patients, early coagulopathy is common on hospital admission. No studies have evaluated the initial coagulation status in the pre-hospital setting. We hypothesise that the coagulopathic process begins at the time of trauma. We studied the on-scene and on hospital arrival coagulation profile of trauma patients.Prospective, observational study investigating the on-scene coagulation profile and its time course. We studied 45 patients at the scene of the accident, before fluid administration, and on hospital admission and classified their coagulopathy using the International Society on Thrombosis and Haemostasis score during a 2-month period. Prothrombin time, activated partial thromboplastin time, fibrinogen concentration, factors II, V and VII activity, fibrin degradation products, antithrombin and protein C activities, platelet counts and base deficit were measured.The median injury severity score was 25 (13-35). On-scene, coagulation status was abnormal in 56% of patients. Protein C activities were decreased in the trauma-associated coagulopathy group (p=.02). Drops in protein C activities were associated with changes in activated partial thromboplastin time, prothrombin time, fibrinogen concentration, factor V and antithrombin activities. Only factor V levels decreased significantly with the severity of the trauma. On hospital admission, coagulation status was abnormal in 60% of patients. The on-scene coagulopathy was spontaneously normalised only in 2 patients whereas others had the same or a poorer coagulopathy status. All parameters of coagulation were significantly abnormal comparing to the on-scene phase. Decreases in protein C activities were related to the coagulation status (p.0001) and changes in other coagulation parameters. Patients with base deficit ≤-6 mmol/L had changes in antithrombin, factor V and protein C activities but no significant coagulopathy.Coagulopathy occurs very early after injury, before fluid administration, at the site of accident. Coagulation and fibrinolytic systems are activated early. The incidence of coagulopathy is high and its severity is related to the injury and not to hypoperfusion. |
| Databáze: | OpenAIRE |
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