Upon admission coagulation and platelet function in patients with thermal and electrical injuries.
BACKGROUND
There has been increased focus on hemostatic potential and function in the initial assessment of the patient with traumatic injuries, that not been extensively studied in patients with burns. We proposed to determine the hemostatic potential of patients with burns upon admission to the emergency department and contrasted their condition with that of healthy controls and patients with other traumatic injuries. In addition we assessed differences due to thermal versus electrical injury and evaluated the effect of burn size.


METHODS
This is a patient based prospective observational study conducted with delayed consented. Subjects at the highest level of trauma activation upon admission to the ED had a blood sample collected for research purposes and were subsequently consented. Hemostatic potential was measured by rapid thromelastography (r-TEG®), thrombin generation by calibrated automated thrombogram (CAT) and platelet function by Multiplate®using five activators. Burn subjects were compared to subjects with other traumatic injuries and controls. Within the burn subjects additional analysis compared mechanism (thermal vs. electrical) and burn size. Values are medians (IQR).


RESULTS
Two hundred and eighty two trauma patients (with burns n=40, 14%) and 27 controls were enrolled. Upon admission, compared to controls, subjects with burns or trauma were hyper-coagulable based on r-TEG and CAT, with increased rates of clot formation and thrombin generation. There were no differences in burns compared to other traumatic injuries. The presence of hyper-coagulation did not appear to be related to the type of burn or the percentage of total body surface area involved. Employing previous defined cut points for R-TEG driven therapeutic interventions burn patients had similar rates of hyper- and hypo-coagulation noted in patients with traumatic injuries.


CONCLUSIONS
Upon admission patients with burns are in a hyper-coagulable state similar to that of other trauma patients. Employing demonstrated cut points of hemostatic potential in trauma patients associated with increased risk of poor outcomes demonstrated the incidence in burn patients to be similar, suggesting that these values could be used in the early assessment of the patient with burns to guide treatment interventions.
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States. Electronic address: Charles.E.Wade@uth.tmc.edu.
Charles E
CE
Wade
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Lisa A
LA
Baer
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Jessica C
JC
Cardenas
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Lindley E
LE
Folkerson
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Kisha
K
Nutall-Aurora
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Bryan A
BA
Cotton
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Nena
N
Matijevic
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
John B
JB
Holcomb
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
James M
JM
Cross
Center for Translational Injury Research and Department of Surgery, University of Texas Health Science Center at Houston, United States.
Todd
T
Huzar
D000328:Adult; D001780:Blood Coagulation Tests; D002056:Burns / Q000097:blood / Q000150:complications; D002058:Burns, Electric / Q000097:blood* / Q000150:complications; D016022:Case-Control Studies; D004556:Electric Injuries / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010973:Platelet Adhesiveness; D010974:Platelet Aggregation; D010979:Platelet Function Tests; D011446:Prospective Studies; D013916:Thrombelastography; D013917:Thrombin; D019851:Thrombophilia / Q000097:blood* / Q000150:complications; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications; D055815:Young Adult
D013917:Thrombin
Burn; Multiplate; Thrombin generation; Trauma; Viscoelastometry