Trauma Sciences, Blizard Institute of Cell and Molecular Science, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK.
Crit Care Med. 2011 Dec;39(12):2652-8. doi: 10.1097/CCM.0b013e3182281af5.
To identify an appropriate diagnostic tool for the early diagnosis of acute traumatic coagulopathy and validate this modality through prediction of transfusion requirements in trauma hemorrhage.
Prospective observational cohort study.
Level 1 trauma center.
Adult trauma patients who met the local criteria for full trauma team activation. Exclusion criteria included emergency department arrival >2 hrs after injury, >2000 mL of intravenous fluid before emergency department arrival, or transfer from another hospital.
None.
Blood was collected on arrival in the emergency department and analyzed with laboratory prothrombin time, point-of-care prothrombin time, and rotational thromboelastometry. Prothrombin time ratio was calculated and acute traumatic coagulopathy defined as laboratory prothrombin time ratio >1.2. Transfusion requirements were recorded for the first 12 hrs following admission.
Three hundred patients were included in the study. Laboratory prothrombin time results were available at a median of 78 (62-103) mins. Point-of-care prothrombin time ratio had reduced agreement with laboratory prothrombin time ratio in patients with acute traumatic coagulopathy, with 29% false-negative results. In acute traumatic coagulopathy, the rotational thromboelastometry clot amplitude at 5 mins was diminished by 42%, and this persisted throughout clot maturation. Rotational thromboelastometry clotting time was not significantly prolonged. Clot amplitude at a 5-min threshold of ≤35 mm had a detection rate of 77% for acute traumatic coagulopathy with a false-positive rate of 13%. Patients with clot amplitude at 5 mins ≤35 mm were more likely to receive red cell (46% vs. 17%, p < .001) and plasma (37% vs. 11%, p < .001) transfusions. The clot amplitude at 5 mins could identify patients who would require massive transfusion (detection rate of 71%, vs. 43% for prothrombin time ratio >1.2, p < .001).
In trauma hemorrhage, prothrombin time ratio is not rapidly available from the laboratory and point-of-care devices can be inaccurate. Acute traumatic coagulopathy is functionally characterized by a reduction in clot strength. With a threshold of clot amplitude at 5 mins of ≤35 mm, rotational thromboelastometry can identify acute traumatic coagulopathy at 5 mins and predict the need for massive transfusion.
确定一种用于早期诊断急性创伤性凝血病的合适诊断工具，并通过预测创伤性出血中的输血需求来验证该方法。
前瞻性观察队列研究。
1 级创伤中心。
符合当地标准的接受完整创伤团队激活的成年创伤患者。排除标准包括受伤后急诊科就诊时间超过 2 小时、急诊科就诊前静脉输液超过 2000 毫升或从其他医院转来。
无。
在急诊科到达时采集血液，并进行实验室凝血酶原时间、即时检测凝血酶原时间和旋转血栓弹性测定分析。计算凝血酶原时间比值，并将实验室凝血酶原时间比值 >1.2 定义为急性创伤性凝血病。记录入院后 12 小时内的输血需求。
本研究共纳入 300 例患者。实验室凝血酶原时间结果的中位数为 78（62-103）分钟。即时检测凝血酶原时间比值在急性创伤性凝血病患者中与实验室凝血酶原时间比值的一致性降低，假阴性率为 29%。在急性创伤性凝血病中，5 分钟时旋转血栓弹性测定的血凝块幅度减少了 42%，并且在整个血凝块成熟过程中持续存在。旋转血栓弹性测定的凝血时间没有明显延长。血凝块幅度在 5 分钟时的阈值≤35mm 的检测率为 77%，假阳性率为 13%。在 5 分钟时血凝块幅度≤35mm 的患者更有可能接受红细胞（46%比 17%，p<0.001）和血浆（37%比 11%，p<0.001）输血。5 分钟时的血凝块幅度可以识别需要大量输血的患者（检测率为 71%，与凝血酶原时间比值>1.2 的 43%相比，p<0.001）。
在创伤性出血中，实验室不能迅速获得凝血酶原时间比值，即时检测设备可能不准确。急性创伤性凝血病的功能特征是血凝块强度降低。当血凝块幅度在 5 分钟时的阈值≤35mm 时，旋转血栓弹性测定可以在 5 分钟时识别急性创伤性凝血病，并预测需要大量输血。
