Hemocoagulation disorders in extensively burned patients: pilot study for scoring of the DIC.
OBJECTIVE
To apply results of the hemocoagulation parameters to the DIC (disseminated intravascular coagulation) score system. Compare parameters of the DIC score in patients with extensive burn trauma (hospitalized at the Intensive Care Unit, ICU) and patients with lesser extent of burn injury (hospitalized at the standard unit). To use these data within the evidence based medicine for the prediction of organ damage and multi-organ failure.


METHODS
Prospective study.


METHODS
We have included total of 36 patients in the group within four months. Twelve patients were hospitalized at the ICU, 24 patients were hospitalized at the intermedial care and standard unit. Repeatedly, we have taken blood from patients to evaluate the hemocoagulation parameters. In patients hospitalized at the ICU, the blood was taken from the central vein (prior to the drawn, the access was flushed with 100 ml of F1/1, the blood was taken from different access than from the one administering heparin), in patients hospitalized at the standard unit the blood was taken from a peripheral vein. The results were then put into the tables established according to the ISTH (International Society on Thrombosis and Hemostasis). Next, the DIC score was calculated to predict severity of hemocoagulation balance disorders in burn trauma, or occurrence of complications during the treatment.


RESULTS
Part 1: We have evaluated 12 patients (4 females) hospitalized at the ICU. At the day of injury the overt DIC score reached 1.25 (0-3), fifth day after the injury the average value of overt DIC score was 1.83 (0-3), one day after the autotransplantation it was 2.08 (0-3) and at the day of discharge from the hospital 0. In the deceased patient the DIC score reached value of 2. Part 2: We evaluated 24 patients (10 females) hospitalized at the standard unit. The extent of their burn injury was 5.9% TBSA (0.5-12% TBSA), age 49.13 years (17-94 years). At the day of injury the overt DIC score reached 0.25 (0-2). Fifth day after the injury the average value of overt DIC score was 1.66 (0-2). Day after the autotransplantation it was 1.83 (0-3) and at the day of discharge 0.02 (0-2).


CONCLUSIONS
During the treatment of the patients with various extent of burn injury, none of the patients' scores reached values that would mean occurrence of obvious "overt" DIC.
Lipový
B
B
Department of Burns and Reconstructive Surgery, Medical Faculty, Masaryk University Brno, Czech Republic. B.Lipovy@seznam.cz
Kaloudová
Y
Y
Matýsková
M
M
Penka
M
M
Rihová
H
H
Brychta
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000453:epidemiology*; D015897:Comorbidity; D004211:Disseminated Intravascular Coagulation / Q000453:epidemiology*; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology; D010865:Pilot Projects; D011446:Prospective Studies; D018570:Risk Assessment; D055815:Young Adult
D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D