From the Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon.
J Trauma Acute Care Surg. 2014 Jul;77(1):67-72; discussion 72. doi: 10.1097/TA.0000000000000255.
Coagulopathy following trauma is associated with poor outcomes. Traumatic brain injury has been associated with coagulopathy out of proportion to other body regions. We hypothesized that injury severity and shock determine coagulopathy independent of body region injured.
We performed a prospective, multicenter observational study at three Level 1 trauma centers. Conventional coagulation tests (CCTs) and rapid thrombelastography (r-TEG) were used. Admission vital signs, base deficit (BD), CCTs, and r-TEG data were collected. The Abbreviated Injury Scale (AIS) score and Injury Severity Score (ISS) were obtained. Severe injury was defined as AIS score greater than or equal to 3 for each body region. Patients were grouped according to their dominant AIS region of injury. Dominant region of injury was defined as the single region with the highest AIS score. Patients with two or more regions with the same greatest AIS score and patients without a region with an AIS score greater than or equal to 3 were excluded. Coagulation parameters were compared between the dominant AIS region. Significant hypoperfusion was defined as BD greater than or equal to 6.
Of the 795 patients enrolled, 462 met criteria for grouping by dominant AIS region. Patients were predominantly white (59%), were male (75%), experienced blunt trauma (71%), and had a median ISS of 25 (interquartile range, 14-29). Patients with BD greater than or equal to 6 (n = 110) were hypocoagulable by CCT and r-TEG compared with patients with BD less than 6 (n = 223). Patients grouped by dominant AIS region showed no significant differences for any r-TEG or CCT parameter. Patients with BD greater than or equal to 6 demonstrated no difference in any r-TEG or CCT parameter between dominant AIS regions.
Coagulopathy results from a combination of tissue injury and shock independent of the dominant region of injury. With the use of AIS as a measure of injury severity, traumatic brain injury was not independently associated with more profound coagulopathy.
Epidemiologic study, level III.
创伤后出现的凝血功能障碍与不良预后有关。颅脑损伤与其他身体部位相比，其凝血功能障碍不成比例。我们假设损伤严重程度和休克决定凝血功能障碍，与受伤的身体部位无关。
我们在三个 1 级创伤中心进行了一项前瞻性、多中心观察性研究。使用常规凝血试验（CCT）和快速血栓弹性描记术（r-TEG）。收集入院生命体征、基础不足（BD）、CCT 和 r-TEG 数据。获得简明损伤量表（AIS）评分和损伤严重程度评分（ISS）。严重损伤定义为每个身体部位的 AIS 评分大于或等于 3。根据主导性 AIS 损伤区域对患者进行分组。主导性损伤区域定义为 AIS 评分最高的单一区域。排除具有两个或更多相同最高 AIS 评分区域或没有 AIS 评分大于或等于 3 的区域的患者。比较主导性 AIS 区域之间的凝血参数。显著低灌注定义为 BD 大于或等于 6。
在纳入的 795 名患者中，有 462 名符合按主导性 AIS 区域分组的标准。患者主要为白人（59%），男性（75%），经历过钝器伤（71%），中位 ISS 为 25（四分位距，14-29）。BD 大于或等于 6（n=110）的患者在 CCT 和 r-TEG 方面比 BD 小于 6（n=223）的患者更易发生低凝。按主导性 AIS 区域分组的患者，r-TEG 和 CCT 的任何参数之间均无显著差异。BD 大于或等于 6 的患者，主导性 AIS 区域之间的 r-TEG 或 CCT 任何参数均无差异。
凝血功能障碍是由组织损伤和休克共同作用的结果，与主导性损伤区域无关。使用 AIS 作为损伤严重程度的衡量标准，颅脑损伤与更严重的凝血功能障碍无关。
流行病学研究，III 级。
