Predicting Life-threatening Coagulopathy in the Massively Transfused Trauma Patient: Hypothermia and Acidoses Revisited.

TitlePredicting Life-threatening Coagulopathy in the Massively Transfused Trauma Patient: Hypothermia and Acidoses Revisited.
Publication TypeJournal Article
Year of Publication1997
AuthorsCosgriff N, Moore E, Sauaia A, Kenny-Moynihan M, Burch J, Galloway B
Journal//J Trauma
Volume42
Issue5
Pagination857 - 862
Date Published1997
ISBN Number0022-5282
Other Numberskaf, 0376373
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]
Abstract

Background: Recalcitrant coagulopathy "the bloody vicious cycle," 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 > 15 years old who received a massive transfusion (> 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 < 7.10 (12.3), (2) temperature < 34degreesC (8.7), (3) ISS > 25 (7.7), and (4) systolic blood pressure < 70 mm Hg (5.8). The conditional probability of developing coagulopathy was ISS > 25 + systolic blood pressure < 70 mm Hg = 39%, ISS > 25 + temperature < 34degreesC = 49%, ISS > 25 + pH < 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 & Wilkins 1997. All Rights Reserved.

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