Acute traumatic coagulopathy.
BACKGROUND
Traumatic coagulopathy is thought to be caused primarily by fluid administration and hypothermia.


METHODS
A retrospective study was performed to determine whether coagulopathy resulting from the injury itself is a clinically important entity in severely injured patients.


RESULTS
One thousand eight hundred sixty-seven consecutive trauma patients were reviewed, of whom 1,088 had full data sets. Median Injury Severity Score was 20, and 57.7% had an Injury Severity Score > 15; 24.4% of patients had a significant coagulopathy. Patients with an acute coagulopathy had significantly higher mortality (46.0% vs. 10.9%; chi2, p < 0.001). The incidence of coagulopathy increased with severity of injury, but was not related to the volume of intravenous fluid administered (r2 = 0.25, p < 0.001).


CONCLUSIONS
There is a common and clinically important acute traumatic coagulopathy that is not related to fluid administration. This is a marker of injury severity and is related to mortality. A coagulation screen is an important early test in severely injured patients.
Brohi
Karim
K
Trauma and Critical Care Unit, Royal London Hospital, United Kingdom. karim@trauma.org
Singh
Jasmin
J
Heron
Mischa
M
Coats
Timothy
T
D000208:Acute Disease; D001778:Blood Coagulation Disorders / Q000453:epidemiology*; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008131:London / Q000453:epidemiology; D008297:Male; D009104:Multiple Trauma / Q000145:classification / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D014949:Wounds, Nonpenetrating / Q000453:epidemiology