Department of Emergency Medicine, College of Medicine, Korea University, Seoul, South Korea.
Emerg Med J. 2012 Nov;29(11):906-10. doi: 10.1136/emermed-2011-200630. Epub 2011 Dec 20.
To determine whether acute traumatic coagulopathy (ATC) should be combined with the trauma and injury severity score (TRISS) to predict outcome in severe trauma patients and investigate effects of the change in coagulation state during early resuscitation on the actual survival rate.
This was a retrospective study. Significant variables that affected 28-day mortality were analysed using multivariate logistic regression. Study patients were classified into three groups: no coagulopathy, mild coagulopathy or severe coagulopathy. Concordance between actual and predicted survival rates were compared for each group. The predicted survival rate was calculated using the TRISS method. The study also determined whether changes in the coagulation state during inhospital resuscitation affected the relationship between actual and predicted survival in patients who had rechecked coagulation profile within 12 h after presentation.
Data from a total of 336 patients were analysed. At presentation, 20.8% of the study patients had mild coagulopathy, whereas 7.7% had severe coagulopathy. Age, injury severity score, revised trauma score and presence of ATC at presentation were independently associated with 28-day mortality. Actual survival was significantly lower than predicted survival in the mild and severe coagulopathy groups. Aggravation of coagulation state from normal or mild to severe coagulopathy or persistent severe coagulopathy during inhospital resuscitation mainly contributed to the discrepancy between actual and predicted survival.
ATC decreased actual survival more than expected. ATC should be combined with TRISS to predict trauma outcome in severely injured patients. Improvement in coagulopathy during resuscitation may reduce the incidence of preventable death after trauma.
确定急性创伤性凝血病（ATC）是否应与创伤和损伤严重程度评分（TRISS）相结合，以预测严重创伤患者的结局，并探讨早期复苏过程中凝血状态的变化对实际生存率的影响。
这是一项回顾性研究。使用多变量逻辑回归分析影响 28 天死亡率的显著变量。将研究患者分为三组：无凝血病、轻度凝血病或重度凝血病。比较每组实际生存率和预测生存率的一致性。使用 TRISS 方法计算预测生存率。该研究还确定了在入院复苏过程中凝血状态的变化是否会影响在就诊后 12 小时内重新检查凝血谱的患者的实际生存率和预测生存率之间的关系。
共分析了 336 例患者的数据。在就诊时，20.8%的研究患者有轻度凝血病，而 7.7%有重度凝血病。就诊时的年龄、损伤严重程度评分、修订创伤评分和 ATC 的存在与 28 天死亡率独立相关。轻度和重度凝血病组的实际生存率明显低于预测生存率。在入院复苏过程中，凝血状态从正常或轻度加重至重度凝血病或持续重度凝血病主要导致实际生存率和预测生存率之间存在差异。
ATC 降低了实际生存率，超过了预期。ATC 应与 TRISS 相结合，以预测严重创伤患者的创伤结局。复苏过程中凝血障碍的改善可能会降低创伤后可预防死亡的发生率。
