title: Application of the Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria for patients at an early phase of trauma.
abstract: BACKGROUND
  To validate the diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) at an early stage of trauma and to evaluate the hypothesis that the JAAM criteria can diagnose DIC with a higher sensitivity than the International Society on Thrombosis and Haemostasis (ISTH) overt DIC criteria.
  
  
  METHODS
  Based on a review of medical records, the data of 314 trauma patients were retrospectively obtained at 4 time points within 24 hr after arrival to the Emergency Department.
  
  
  RESULTS
  One hundred and forty-one JAAM DIC patients (44.9%) showed differences in the prevalence of massive bleeding and multiple organ dysfunction syndrome (MODS), and the outcome in comparison to the non-DIC patients. A stepwise logistic regression analysis showed that the maximum JAAM DIC scores independently predicted the patient death. All of the patients who developed ISTH overt DIC could be identified by the JAAM DIC criteria at early time points. The mortality rate and the incidence of massive bleeding and MODS of the patients with the ISTH overt DIC were higher than those only met the JAAM DIC criteria. Stepwise increases in the ISTH overt DIC scores and the incidence of the overt DIC were observed in accordance with the increases in the JAAM DIC scores. While the mortality rates were identical, there were marked differences in the incidence of MODS and Sequential Organ Failure Assessment scores between the DIC patients associated with trauma and sepsis.
  
  
  CONCLUSIONS
  The results show that the JAAM scoring system has acceptable validity for the DIC diagnosis at an early phase of trauma, and also that the scoring system can diagnose DIC with a higher sensitivity than the criteria of the ISTH overt DIC. Bleeding as well as MODS may affect the prognosis of the patients associated with DIC.
authors: Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N17W5, Kita-ku, Sapporo, 060-8638 Japan.
authors: Atsushi
authors: A
authors: Sawamura
authors: Mineji
authors: M
authors: Hayakawa
authors: Satoshi
authors: S
authors: Gando
authors: Nobuhiko
authors: N
authors: Kubota
authors: Masahiro
authors: M
authors: Sugano
authors: Takeshi
authors: T
authors: Wada
authors: Ken-ichi
authors: K
authors: Katabami
mesh_terms: D000328:Adult; D000368:Aged; D002309:Cardiology / Q000379:methods; D004211:Disseminated Intravascular Coagulation / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000145:classification / Q000175:diagnosis; D013997:Time Factors; D014947:Wounds and Injuries / Q000145:classification / Q000175:diagnosis