title: What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan.
abstract: OBJECTIVE
  The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM).
  
  
  METHODS
  Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study. We evaluated (1) the characteristics of T-DIC, (2) the relationships between T-DIC and each parameter of the JAAM DIC criteria and (3) the diagnostic accuracies of each parameter for T-DIC by statistical measurement.
  
  
  RESULTS
  All 72 patients (21 T-DIC and 51 control) were included in primary analysis. T-DIC was significantly related to younger age, more severe trauma scores, more cases of massive transfusions, and remarkable coagulation abnormality detected by standard coagulation tests. In the cases of T-DIC, ROTEM showed longer clotting time, lower acceleration, lower clot firmness, and inhibited fibrinolysis in EXTEM/INTEM. Within the JAAM DIC score, PT-INR ≥1.2 was the most accurate factor for T-DIC diagnosis; sensitivity 60.0%, specificity 100.0%, and accuracy 88.7%. PT-INR ≥1.2 was statistically correlated with the JAAM DIC score (p < 0.001, r = 0.709). The univariate analysis based on 1.2 of PT-INR indicated statistical differences in most categories of ROTEM, which is similar to analysis performed for the presence and absence of T-DIC.
  
  
  CONCLUSIONS
  Among JAAM DIC criteria, the PT-INR ≥1.2 was the most accurate factor for both the diagnosis of T-DIC and the evaluation of its severity.
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan. hkoami@cc.saga-u.ac.jp.
authors.forename: H
authors.identifier: http://orcid.org/0000-0001-6268-4602
authors.initials: H
authors.lastname: Koami
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakamoto
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: K C
authors.initials: KC
authors.lastname: Yamada
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Matsuda
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Nishi
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Nakayama
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Sakurai
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ohta
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Imahase
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Yahata
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Umeka
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Miike
authors.affiliation: Advanced Emergency Care Center, Saga University Hospital, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: F
authors.initials: F
authors.lastname: Nagashima
authors.affiliation: Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Iwamura
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Faculty of Medicine, Saga University, 5-1-1, Nabeshima, Saga City, Saga, 8498501, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Inoue
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D016022:Case-Control Studies; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013916:Thrombelastography
keywords: DIC; JAAM DIC score; PT-INR; Thromboelastometry; Trauma