Liou Douglas Z, Shafi Hedyeh, Bloom Matthew B, Chung Rex, Ley Eric J, Salim Ali, Tcherniantchouk Oxana, Margulies Daniel R
Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Am Surg. 2014 Oct;80(10):994-8.
Early trauma-induced coagulopathy (ETIC) is abnormal coagulation detected on presentation, but a clear description is lacking. We used thromboelastography (TEG) to characterize ETIC. Data were prospectively collected on high-acuity trauma activations at an urban Level I trauma center between July 2012 and May 2013. Patients with admission TEG before any blood transfusion were stratified by Injury Severity Score (ISS): mild (less than 16), moderate (16 to 24), severe (25 or greater). TEG parameters were compared between groups. ETIC was defined as any abnormality detected on TEG. Fifty-two patients were included; mean age was 49 years and mean time to the emergency department was 26 minutes. Mean ISS for the cohort was 17 with 28 patients in mild, eight in moderate, and 16 in severe. Glasgow Coma Score was lower and head Abbreviated Injury Scale was higher in severe (P < 0.001). Forty-three (83%) patients had an abnormal TEG. Shortened reaction (R) time was noted in 42 patients. There were no differences in any TEG parameters between the injury severity groups. Hyperfibrinolysis was detected in four (8%) patients. ETIC was present in over 80 per cent of high-acuity trauma activations irrespective of injury severity and characterized primarily by shortened R time, indicating ETIC is initially described by a hypercoagulable state as a result of thrombin generation.
早期创伤性凝血病（ETIC）是指在就诊时检测到的凝血异常，但目前缺乏清晰的描述。我们使用血栓弹力图（TEG）来对ETIC进行特征性描述。前瞻性收集了2012年7月至2013年5月期间在一家城市一级创伤中心进行的高 acuity 创伤激活的数据。在任何输血前进行入院TEG检查的患者按损伤严重程度评分（ISS）分层：轻度（小于16）、中度（16至24）、重度（25或更高）。比较各组之间的TEG参数。ETIC定义为TEG检测到的任何异常。纳入了52例患者；平均年龄为49岁，平均到达急诊科时间为26分钟。该队列的平均ISS为17，其中28例为轻度，8例为中度，16例为重度。重度患者的格拉斯哥昏迷评分较低，头部简明损伤量表评分较高（P<0.001）。43例（83%）患者的TEG异常。42例患者出现反应（R）时间缩短。损伤严重程度组之间的任何TEG参数均无差异。4例（8%）患者检测到纤溶亢进。无论损伤严重程度如何，超过80%的高 acuity 创伤激活中存在ETIC，其主要特征为R时间缩短，表明ETIC最初表现为由于凝血酶生成导致的高凝状态。
