Universität zu Köln

Wafaisade, Arasch, Wutzler, Sebastian, Lefering, Rolf, Tjardes, Thorsten, Banerjee, Marc, Paffrath, Thomas, Bouillon, Bertil and Maegele, Marc (2010). Drivers of acute coagulopathy after severe trauma: a multivariate analysis of 1987 patients. Emerg. Med. J., 27 (12). S. 934 - 940. LONDON: B M J PUBLISHING GROUP. ISSN 1472-0205

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Abstract

Objective The role of acute coagulopathy after severe trauma as a major contributor to exsanguination and death has recently gained increasing appreciation, but the causes and mechanisms are not fully understood. This study was conducted to assess the risk factors associated with acute traumatic coagulopathy together with quantitative estimates of their importance. Methods Using the multicentre Trauma Registry of the German Society for Trauma Surgery, adult trauma patients with an Injury Severity Score >= 16 were retrospectively analysed for independent risk factors of acute traumatic coagulopathy on arrival at the emergency department (ED) by multivariate stepwise logistic regression analysis. Coagulopathy was defined as prothrombin time test (Quick's value) <70% and/or platelets <100 000/mu l. Results A total of 1987 patients was eligible for further analysis. Independent risk factors for acute traumatic coagulopathy calculated by multivariate analysis were the Injury Severity Score, abdomen Abbreviated Injury Scale score, base excess, body temperature <= 35 degrees C, presence of shock at the scene and/or in the ED (defined as systolic blood pressure <= 90 mm Hg), prehospital intravenous colloid: crystalloid ratio >= 1:2 and amount of prehospital intravenous fluids >= 3000 ml. Conclusions The risk factors from multivariate analysis correspond to the current understanding that coagulopathy is influenced by several clinical key factors; for example, an ongoing state of shock (at the scene and in the ED) was associated with a threefold increased risk of developing coagulopathy. When adjusted for all factors including the amount of prehospital intravenous fluids, a high colloid: crystalloid ratio was still associated with coagulopathy on admission to the ED. The recognition, prevention and management of the mechanisms and risk factors of coagulopathy aggravating haemorrhage after trauma are critical in the treatment of the severely injured patient.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wafaisade, Arasch UNSPECIFIED UNSPECIFIED UNSPECIFIED Wutzler, Sebastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Lefering, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED Tjardes, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Banerjee, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Paffrath, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-491349
DOI:	10.1136/emj.2009.088484
Journal or Publication Title:	Emerg. Med. J.
Volume:	27
Number:	12
Page Range:	S. 934 - 940
Date:	2010
Publisher:	B M J PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1472-0205
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ABDOMINAL-TRAUMA; INJURY; COAGULATION; MORTALITY; BLOOD; RESUSCITATION; TRANSFUSION; ACIDOSIS; REGISTRY; TEMPERATURE Multiple languages Emergency Medicine Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49134