Increased mortality associated with the early coagulopathy of trauma in combat casualties
Increased mortality associated with the early coagulopathy of trauma in combat casualties
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DOI：
10.1097/ta.0b013e318174e8bc
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发表时间：
2008-06-01
影响因子：
--
通讯作者：
Holcomb, John B.
中科院分区：
文献类型：
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作者：
Niles, Sarah E.;McLaughlin, Daniel F.;Holcomb, John B.
背景资料：最近的民间研究已经证明了死亡率增加与急诊科（艾德）诊断的创伤早期凝血功能障碍之间的关系。我们假设，急性凝血功能障碍（国际标准化比率>= 1.5）在战斗中的伤亡与受伤的严重程度和死亡率增加，是在平民traumatic patients.Methods：一项回顾性研究的战斗伤员谁收到了输血在一个单一的战斗支持医院在2003年9月和2004年12月之间进行。凝血状态，pH值，碱赤字，并记录在抵达ED的温度。这些进行了分析的损伤严重程度评分（ISS），相关的损伤模式，和mortality。在研究期间，共有3 287名病人在战斗支援医院接受治疗。其中，391名患者接受了输血并首次入院，因此符合研究标准，347名患者有凝血数据，92%有穿透机制。在到达艾德时用即时检测设备测量的输血伤员中急性凝血病的患病率为38%。到达艾德时有凝血功能障碍的患者的死亡率为24%（32/133），而无凝血功能障碍的患者的死亡率为4%（8/214）（p < 0.001）。随着ISS的增加，凝血障碍导致的死亡率也增加。凝血障碍和酸中毒与死亡率相关，比值比（OR）分别为5.38 [95%置信区间（CI），1.55-11.37]和6.9（95% CI，2.1-19.5）。温度没有影响结果（OR，1.1; 95%CI，0.4-2.6）。结论：创伤的早期凝血功能障碍在艾德中被迅速诊断，并且在超过三分之一的接受输血的战斗伤员中存在，与平民创伤患者的发病率相似。凝血功能障碍与低体温无关，但与酸中毒和ISS密切相关，与战斗伤亡人员的死亡率相关，与平民创伤患者相似。早期诊断和治疗急性创伤性凝血病与新的复苏范例可能会改善结果。
Background: Recent civilian studies have documented a relationship between increased mortality and the presence of an early coagulopathy of trauma diagnosed in the emergency department (ED). We hypothesized that acute coagulopathy (international normalized ratio >= 1.5) in combat casualties was associated with increased injury severity and mortality as is seen in civilian trauma patients.Methods: A retrospective study of combat casualties who received a blood transfusion at a single combat support hospital between September 2003 and December 2004 was performed. Coagulation status, pH, base deficit, and temperature were recorded at arrival to the ED. These were analyzed by Injury Severity Score (ISS), associated injury patterns, and mortality.Results:. A total of 3,287 patients were treated at the combat support hospital during the study period. Of these, 391 patients were transfused and primarily admitted, thus meeting the study criteria, 347 had coagulation data, and 92% had a penetrating mechanism. The prevalence of acute coagulopathy in transfused casualties measured with point-of-care devices at arrival in the ED was 38%. Mortality in those who were coagulopathic at arrival to the ED was 24% (32/133) versus 4% (8/214) in those not presenting with coagulopathy (p < 0.001). The prevalence of mortality by coagulopathy increased as ISS increased. Coagulopathy and acidosis were associated with mortality, odds ratio (OR), 5.38 [95% confidence interval (CI), 1.55-11.37] and 6.9 (95% CI, 2.1-19.5), respectively. Temperature did not affect outcomes (OR, 1.1; 95% CI, 0.4-2.6).Conclusions: The early coagulopathy of trauma was rapidly diagnosed in the ED and present in more than one-third of combat casualties who received a transfusion, similar to the incidence found in civilian trauma patients. Coagulopathy, independent of hypothermia but strongly correlated with acidosis and ISS, was associated with mortality in combat casualties, similar to that found in civilian trauma patients. Early diagnosis and treatment of acute traumatic coagulopathy with new resuscitation paradigms may improve outcomes.