title: Acute burn induced coagulopathy.
abstract: BACKGROUND
  Acute traumatic coagulopathy is well described in the trauma population. Major burns are characterised by a similar endothelial injury and cellular hypoperfusion. These features could be a driver for an acute burn induced coagulopathy (ABIC).
  
  
  METHODS
  Patients admitted to a regional burn centre over a 71 months period with a total body surface area burn of 30% or more were identified. The metavision electronic patient database was scrutinised for a predetermined list of demographics, interventions and admission investigations to identify any clinically significant ABIC.
  
  
  RESULTS
  On admission 39.3% of the 117 patients analysed met our criteria for a coagulopathy. Of the patients with a coagulopathy, 71.7% had an elevated Prothrombin Time (PT), 2.2% had an elevated Activated Partial Thromboplastin time (APPT) and 26.1% had an elevation of both. Patients with a coagulopathy received a similar volume of fluid (p=0.08). There was a statistically significant correlation between the PT and the abbreviated burn severity index (p=0.0013, r=0.292) and serum lactate (p=0.0013, r=0.292). ABIC was an independent predictor of 28 day mortality, OR 3.42(1.11-10.56).
  
  
  CONCLUSIONS
  In patients with major thermal injuries a clinically significant ABIC exists. Early diagnosis and treatment of ABIC should be considered particularly in those undergoing total burn wound excision.
authors.affiliation: Department of Pre-hospital Emergency Medicine, Greater Sydney Area Helicopter Emergency Medical Service, Ambulance Service of New South Wales, Australia. petersherren@gmail.com
authors.forename: P B
authors.initials: PB
authors.lastname: Sherren
authors.forename: J
authors.initials: J
authors.lastname: Hussey
authors.forename: R
authors.initials: R
authors.lastname: Martin
authors.forename: T
authors.initials: T
authors.lastname: Kundishora
authors.forename: M
authors.initials: M
authors.lastname: Parker
authors.forename: B
authors.initials: B
authors.lastname: Emerson
mesh_terms: D015998:Abbreviated Injury Scale; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000209:etiology*; D002056:Burns / Q000097:blood / Q000150:complications* / Q000401:mortality; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D011517:Prothrombin Time; D055815:Young Adult
keywords: Abbreviated burn severity index (ABSI); Activated partial thromboplastin time (APTT); Burn; Coagulopathy; Prothrombin time (PT)