Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany.
Emerg Med J. 2010 Dec;27(12):934-9. doi: 10.1136/emj.2009.088484. Epub 2010 Jun 1.
The role of acute coagulopathy after severe trauma as a major contributor to exsanguination and death has recently gained increasing appreciation, but the causes and mechanisms are not fully understood. This study was conducted to assess the risk factors associated with acute traumatic coagulopathy together with quantitative estimates of their importance.
Using the multicentre Trauma Registry of the German Society for Trauma Surgery, adult trauma patients with an Injury Severity Score ≥16 were retrospectively analysed for independent risk factors of acute traumatic coagulopathy on arrival at the emergency department (ED) by multivariate stepwise logistic regression analysis. Coagulopathy was defined as prothrombin time test (Quick's value) <70% and/or platelets <100,000/μl.
A total of 1987 patients was eligible for further analysis. Independent risk factors for acute traumatic coagulopathy calculated by multivariate analysis were the Injury Severity Score, abdomen Abbreviated Injury Scale score, base excess, body temperature ≤35°C, presence of shock at the scene and/or in the ED (defined as systolic blood pressure ≤90 mm Hg), prehospital intravenous colloid:crystalloid ratio ≥1:2 and amount of prehospital intravenous fluids ≥3000 ml.
The risk factors from multivariate analysis correspond to the current understanding that coagulopathy is influenced by several clinical key factors; for example, an ongoing state of shock (at the scene and in the ED) was associated with a threefold increased risk of developing coagulopathy. When adjusted for all factors including the amount of prehospital intravenous fluids, a high colloid:crystalloid ratio was still associated with coagulopathy on admission to the ED. The recognition, prevention and management of the mechanisms and risk factors of coagulopathy aggravating haemorrhage after trauma are critical in the treatment of the severely injured patient.
严重创伤后急性凝血病作为出血和死亡的主要原因，其作用最近受到越来越多的关注，但发病原因和机制尚不完全清楚。本研究旨在评估与急性创伤性凝血病相关的危险因素，并对其重要性进行定量估计。
利用德国创伤外科学会多中心创伤登记处，对创伤严重度评分≥16 的成年创伤患者进行回顾性分析，采用多变量逐步逻辑回归分析方法，确定到达急诊室时急性创伤性凝血病的独立危险因素。凝血病定义为凝血酶原时间试验（Quick 值）<70%和/或血小板<100,000/μl。
共有 1987 例患者符合进一步分析的条件。多变量分析计算出的急性创伤性凝血病的独立危险因素包括创伤严重度评分、腹部损伤严重度评分、碱缺失、体温≤35°C、现场和/或急诊室存在休克（定义为收缩压≤90mmHg）、院前静脉胶体：晶体比≥1:2 和院前静脉输液量≥3000ml。
多变量分析的危险因素与目前的认识一致，即凝血病受多种临床关键因素影响；例如，持续存在的休克（现场和急诊室）与发生凝血病的风险增加三倍相关。当调整包括院前静脉输液量在内的所有因素时，高胶体：晶体比与入院时的凝血病仍然相关。识别、预防和处理创伤后加重出血的凝血病机制和危险因素对于严重创伤患者的治疗至关重要。
