title: Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy Clinical Score (TICCS).
abstract: BACKGROUND
  Identifying patients who need damage control resuscitation (DCR) early after trauma is pivotal for adequate management of their critical condition. Several trauma-scoring systems have been developed to identify such patients, but most of them are not simple enough to be used in prehospital settings in the early post-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictly clinical trauma score developed to meet this medical need.
  
  
  METHODS
  TICCS is a 3-item clinical score (range: 0 to 18) based on the assessment of general severity, blood pressure and extent of body injury and calculated by paramedics on-site for patients with severe trauma. This non-interventional prospective study was designed to assess the ability of TICCS to discern patients who need DCR. These patients were patients with early acute coagulopathy of trauma (EACT), haemorrhagic shock, massive transfusion and surgical or endovascular haemostasis during hospitalization. Diagnosis of EACT was assessed by both thromboelastometry and conventional coagulation tests.
  
  
  RESULTS
  During an 18-month period, 89 severe trauma patients admitted to the general emergency unit at our hospital were enrolled in the study, but 7 were excluded for protocol violations. Of the 82 remaining patients, 8 needed DCR and 74 did not. With receiver operating characteristic curve analysis, TICCS proved to be a powerful discriminant test (area under the curve = 0.98; 95% CI: 0.92 to 1.0). A cutoff of 10 on the TICCS scale provided the best balance between sensitivity (100%; 95% CI: 53.9 to 100) and specificity (95.9%; 95% CI: 88.2 to 99.2). The positive predictive value was 72.7%, and the negative predictive value was 100.0%.
  
  
  CONCLUSIONS
  TICCS can be easily and rapidly measured by paramedics at the trauma site. In this study of blunt trauma patients, TICCS was able to discriminate between patients with and without need for DCR. TICCS on-site evaluation should allow initiation of optimal care immediately upon hospital admission of patients with severe trauma in need of DCR. However, a larger multicentre prospective study is needed for in-depth validation of TICCS.
  
  
  BACKGROUND
  Clinicaltrials.gov ID: NCT02132208 (registered 6 May 2014).
authors.affiliation: Emergency Medicine, Trauma and Bleeding Care, CHR de la Citadelle, boulevard du 12eme de ligne, 1, 4000, Liège, Belgium. tongletm@yahoo.com.
authors.forename: Martin L
authors.initials: ML
authors.lastname: Tonglet
authors.affiliation: Laboratory and Blood Transfusion Departments, CHR de la Citadelle, boulevard du 12eme de ligne, 1, 4000, Liège, Belgium. jean.marc.minon@chrcitadelle.be.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Minon
authors.affiliation: CHU du Sart Tilman, departement des biostatistiques, domaine du Sart Tilam, B35, 4000, Liège, Belgium. laurence.seidel@ulg.ac.be.
authors.forename: Laurence
authors.initials: L
authors.lastname: Seidel
authors.affiliation: European Drug Development Consulting, rue du Tambour, 4, 4540, Amay, Belgium. poplavskyjl@skynet.be.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Poplavsky
authors.affiliation: Emergency Department, CHR de la Citadelle, boulevard du 12eme de ligne, 1, 4000, Liège, Belgium. michel.vergnion@chrcitadelle.be.
authors.forename: Michel
authors.initials: M
authors.lastname: Vergnion
mesh_terms: D000208:Acute Disease; D000328:Adult; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D011446:Prospective Studies; D012720:Severity of Illness Index; D055815:Young Adult