Functional definition and characterization of acute traumatic coagulopathy.
Functional definition and characterization of acute traumatic coagulopathy.
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DOI：
10.1097/ccm.0b013e3182281af5
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发表时间：
2011-12
影响因子：
8.8
通讯作者：
Brohi K
中科院分区：
文献类型：
--
作者：
Davenport R;Manson J;De'Ath H;Platton S;Coates A;Allard S;Hart D;Pearse R;Pasi KJ;MacCallum P;Stanworth S;Brohi K
确定一种用于急性创伤性凝血病（ATC）早期诊断的适当诊断工具，并通过预测创伤出血的输血需求来验证该模式。前瞻性观察性队列研究1级创伤中心符合当地创伤团队全面激活标准的成人创伤患者。排除标准包括伤后>2小时到达急诊科（艾德），艾德到达前静脉输液> 2000 ml或从另一家医院转移。无到达艾德时采集血液，并使用实验室凝血酶原时间（PT）、床旁（PoC）PT和旋转血栓弹性测量（ROTEM）进行分析。计算凝血酶原比率（PTr），ATC定义为实验室PTr>1.2。记录入院后前12小时的输血要求。300名患者被纳入研究。实验室PT结果在中位78（62-103）分钟时可用。在ATC患者中，PTR与实验室PTr的一致性降低，假阴性结果为29%。在ATC中，5分钟时的ROTEM凝块振幅（CA 5）降低了42%，并且在整个凝块成熟过程中持续存在。ROTEM凝血时间未显著延长。CA 5阈值≤ 35 mm时ATC检出率为77%，假阳性率为13%。CA 5 ≤ 35 mm的患者更可能接受红细胞（46% vs 17%，p<0.001）和血浆（37% vs 11%，p<0.001）输注。CA 5可以识别需要大量输血的患者（检出率为71%，PTr >1.2的患者为43%，p<0.001）。在创伤出血中，PTr不能迅速从实验室获得，并且止血装置可能不准确。ATC在功能上的特征是血凝块强度降低。在CA 5 ≤ 35 mm的阈值下，ROTEM可以在5分钟内识别ATC并预测大量输血的需要。
To identify an appropriate diagnostic tool for the early diagnosis of Acute Traumatic Coagulopathy (ATC) and validate this modality through prediction of transfusion requirements in trauma hemorrhage. Prospective observational cohort study Level 1 trauma centre Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department (ED) arrival >2 hours after injury, >2000ml of intravenous fluid before ED arrival or transfer from another hospital. None Blood was collected on arrival in ED and analysed with laboratory prothrombin time (PT), point of care (PoC) PT and rotational thromboelastometry (ROTEM). Prothrombin ratio (PTr) was calculated and ATC defined as laboratory PTr>1.2. Transfusion requirements were recorded for the first 12 hours following admission. 300 patients were included in the study. Laboratory PT results were available at median 78 (62-103) minutes. PoC PTr had reduced agreement with laboratory PTr in patients with ATC, with 29% false negative results. In ATC the ROTEM Clot Amplitude at 5 minutes (CA5) was diminished by 42% and this persisted throughout clot maturation. ROTEM clotting time was not significantly prolonged. A CA5 threshold ≤35mm had a detection rate of 77% for ATC with a false positive rate of 13%. Patients with CA5 ≤35mm were more likely to receive red cell (46% vs 17%, p<0.001) and plasma (37% vs 11%, p<0.001) transfusions. The CA5 could identify patients who would require massive transfusion (detection rate of 71%, vs 43% for PTr >1.2, p<0.001). In trauma hemorrhage PTr is not rapidly available from the laboratory and PoC devices can be inaccurate. ATC is functionally characterised by a reduction in clot strength. With a threshold of CA5 ≤35mm ROTEM can identify ATC at 5 minutes and predict the need for massive transfusion.