title: Acute traumatic coagulopathy among major trauma patients in an urban tertiary hospital in sub Saharan Africa.
abstract: BACKGROUND
  Mortality from trauma remains a major public health issue as it is the leading cause of death in persons aged 5 to 44 years. Uncontrolled hemorrhage and coagulopathy is responsible for over 50% of all trauma related deaths within the first 48 hrs of admission. Coagulation profiles are not routinely done among trauma patients in resource limited settings and there is a paucity of data on acute traumatic coagulopathy (ATC) in sub Saharan Africa. The study was conducted to evaluate the prothrombin time and partial thromboplastin time (PT/PTT) as predictors of mortality and morbidity among major trauma patients.
  
  
  METHODS
  A prospective cohort study was carried out, in which major trauma patients admitted in A&E department between December 2011 to April 2012 were recruited. Five (5) mls of venous blood was drawn from a convenient vein within 10 minutes of the patient's arrival at A&E for analysis of PT/PTT. Patients were stratified into two groups by the presence/absence of coagulopathy then followed up for a 2 week period for morbidity and mortality.
  
  
  RESULTS
  A total of 182 major trauma patients were recruited; 149 (81.9%) were males, the mean age was 29.5 years (SD 9.8). Prevalence of coagulopathy was 54% (98/182). The mean ISS for the ATC group was 36.9 and the non ATC group was 26.9 (p=0.001). Patients with ATC stayed longer in hospital 11.24 days than non ATC patients 8 days (p=0.001). ATC was strongly associated with ARI (p= 0.003). Mortality was more in the ATC group 29 deaths compared to 9 deaths in the non ATC group. PTT was a strong independent predictor of mortality.
  
  
  CONCLUSIONS
  A significant proportion of major trauma patients were coagulopathic. Initial coagulation profile is useful in predicting outcomes for major trauma patients.
authors.affiliation: Surgery Department, College of Health Sciences, Makerere University, Kampala, Uganda. mosesg@img.co.ug
authors.forename: Erick
authors.initials: E
authors.lastname: Mujuni
authors.forename: Robert
authors.initials: R
authors.lastname: Wangoda
authors.forename: Peter
authors.initials: P
authors.lastname: Ongom
authors.forename: Moses
authors.initials: M
authors.lastname: Galukande
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001778:Blood Coagulation Disorders / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011517:Prothrombin Time; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D014454:Uganda / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality; D014950:Wounds, Penetrating / Q000150:complications* / Q000401:mortality; D055815:Young Adult