Early coagulopathy of major burns.
OBJECTIVE
The pathophysiology and time-course of coagulopathy post major burns are inadequately understood. The aims of this study were to review the incidence of acute coagulopathy post major burns, potential contributing factors associated with this coagulopathy and outcome of patients who developed early coagulopathy.


METHODS
A retrospective review of all patients with major burns (≥20% total body surface area (TBSA)) presenting to a tertiary burns referral centre was conducted. Data on demographic, injury characteristics and fluid resuscitation practices were recorded and tested for association with coagulopathy (INR>1.5 or aPTT>60 s) at hospital presentation and within 24 h of burns injury. Mortality, intensive care unit (ICU) admission, mechanical ventilation and blood and blood product usage were primary endpoints.


RESULTS
There were 99 patients who met the inclusion criteria with 36 (16) %TBSA burns. Coagulopathy was present in only three patients on presentation, but 37 (37%) patients developed early onset (within 24 h of injury) coagulopathy. Early onset coagulopathy was independently associated with %TBSA burnt (p<0.001) and volume of fluid administered (p=0.005). Early onset coagulopathy was associated with higher volumes of blood and blood product administration, ICU admission and prolonged mechanical ventilation.


CONCLUSIONS
Post major burns, a very low proportion of patients presented with coagulopathy, but a substantial proportion of patients developed coagulopathy within 24 h. This and the association of coagulopathy with the volume of fluid resuscitation suggest dilution as a major cause of the early coagulopathy of major burns.
Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, VIC, Australia. b.mitra@alfred.org.au
Biswadev
B
Mitra
Jason
J
Wasiak
Peter A
PA
Cameron
Gerard
G
O'Reilly
Hannah
H
Dobson
Heather
H
Cleland
D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016913:Blood Component Transfusion; D001830:Body Surface Area; D002056:Burns / Q000150:complications* / Q000401:mortality / Q000628:therapy; D042241:Early Diagnosis; D004632:Emergency Medical Services; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012151:Resuscitation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology