title: Development of Novel Criteria of the "Lethal Triad" as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan.
abstract: OBJECTIVE
  To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy.
  
  
  METHODS
  Retrospective observational study.
  
  
  METHODS
  Fifteen acute critical care medical centers in Japan.
  
  
  METHODS
  In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012.
  
  
  METHODS
  None.
  
  
  RESULTS
  All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 µg/mL and -3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%.
  
  
  CONCLUSIONS
  Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.
authors.affiliation: 1Trauma and Acute Critical Care Medical Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.2Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.3Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa, Japan.4Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan.5Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.6Department of Emergency Medicine and Critical Care, National Center For Global Health and Medicine, Tokyo, Japan.7Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan.8Senshu Trauma and Critical Care Center, Rinku General Medical Center, Osaka, Japan.9Department of Emergency and Critical Care Medicine, Kindai University Faculty of Medicine, Osaka, Japan.10Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.11Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.12Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan.13Emergency and Critical Care Center, Fukaya Red Cross Hospital, Saitama, Japan.14Department of Critical Care and Traumatology, National Hospital Organization Disaster Medical Center, Tokyo, Japan.15Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.16Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Kurume, Japan.17Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Tokyo, Japan.
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mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000097:blood / Q000503:physiopathology / Q000628:therapy*