@article {4130,
	title = {Predicting Life-threatening Coagulopathy in the Massively Transfused Trauma Patient: Hypothermia and Acidoses Revisited.},
	journal = {//J Trauma},
	volume = {42},
	year = {1997},
	month = {1997},
	pages = {857 - 862},
	publisher = {From the Departments of Surgery (N.C., E.E.M., A.S., J.M.B.) and Pathology (M.K.-M., B.G.), Denver Health Medical Center, and University of Colorado Health Sciences Center, Denver, Colorado.This work was supported in part by National Institutes of Health },
	address = {(C) Williams \& Wilkins 1997. All Rights Reserved.},
	abstract = {<p>Background: Recalcitrant coagulopathy \&quot;the bloody vicious cycle,\&quot; produces the majority of deaths after torso trauma. A model predicting this life-threatening complication may facilitate clinical decision-making., Methods: We prospectively analyzed patients \&gt; 15 years old who received a massive transfusion (\&gt; 10 units of packed red blood cells (PRBC)/24 h) over a 2-year period. Excluding massive head injuries and pre-existing disease, the 58 study patients had a mean age = 35.4 years, Injury Severity Score (ISS) = 30.6, and PRBC = 24.2 units/24 h., Results: Defined as prothrombin time of two times that of normal laboratory controls and partial thromboplastin time as two times that of normal laboratory controls, 27 patients (47\%) developed life-threatening coagulopathy. Using a multiple logistic regression model, the four significant risk factors (with odds ratio) were (1) pH \&lt; 7.10 (12.3), (2) temperature \&lt; 34degreesC (8.7), (3) ISS \&gt; 25 (7.7), and (4) systolic blood pressure \&lt; 70 mm Hg (5.8). The conditional probability of developing coagulopathy was ISS \&gt; 25 + systolic blood pressure \&lt; 70 mm Hg = 39\%, ISS \&gt; 25 + temperature \&lt; 34degreesC = 49\%, ISS \&gt; 25 + pH \&lt; 7.10 = 49\%; with all four risk factors the incidence was 98\%., Conclusion: Postinjury life-threatening coagulopathy in the seriously injured requiring massive transfusion is predicted by persistent hypothermia and progressive metabolic acidosis., (C) Williams \&amp; Wilkins 1997. All Rights Reserved.</p>},
	keywords = {*Abdominal Injuries/th [Therapy], *Acidosis/et [Etiology], *Blood Coagulation Disorders/et [Etiology], *Blood Transfusion/ae [Adverse Effects], *Hypothermia/et [Etiology], *Thoracic Injuries/th [Therapy], Abdominal Injuries/co [Complications], Adult, Female, Humans, Injury Severity Score, Logistic Models, Male, Odds Ratio, Predictive Value of Tests, Prospective Studies, Risk Factors, Survival Analysis, Thoracic Injuries/co [Complications]},
	isbn = {0022-5282},
	author = {Cosgriff, Ned and Moore, Ernest and Sauaia, Angela and Kenny-Moynihan, Mary and Burch, Jon and Galloway, Ben}
}
