title: International normalized ratio as a predictor of mortality in trauma patients in India.
abstract: BACKGROUND
  Hemorrhage is the second leading cause of death in trauma patients preceded only by traumatic brain injury. But hemorrhagic shock is the most common cause of preventable death within 6 hours of admission. Traumatic coagulopathy is a hypocoagulable state that occurs in the most severely injured. International normalized ratio (INR) and its relationship with trauma mortality have not been studied specifically. This study aimed to establish a predictive value of INR for trauma-related mortality.
  
  
  METHODS
  A total of 99 trauma patients aged 18-70 years were included in the study. Their INR was determined and patient progression was followed up till death/discharge. According to previous retrospective studies, the cutoff value for INR in our study was kept at 1.5.
  
  
  RESULTS
  The total mortality rate of the patients was 16.16% (16/99). The mean INR was 1.45 with a SD of 1.35. INR was deranged in a total of 14 patients (14.14%). Of these patients, 11 died (78.57%) and 3 survived. INR was deranged in 11 (68.75%) of the 16 patients who died, but 5 deaths (31.25%) had normal INR values. The sensitivity of INR was 69% (95%CI 41%-88%) and the specificity 96% (95%CI 90%-99%). The diagnostic accuracy of INR was 92% (95%CI 85%-96%). Positive predictive value and negative predictive value were 79% (95%CI 49%-95%) and 94% (95%CI 87%-98%), respectively.
  
  
  CONCLUSIONS
  Our results showed that INR is a good predictor of mortality in trauma patients.
authors.affiliation: Department of Emergency Medicine, King Hamad University Hospital, Busaiteen, Kingdom of Bahrain, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Verma
authors.affiliation: Department of Emergency Medicine, Max Hospital, Saket, New Delhi 110017, India.
authors.forename: Tamorish
authors.initials: T
authors.lastname: Kole
keywords: Hemorrhage; International normalized ratio; Mortality; Trauma