Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany.
Biomed Res Int. 2020 Dec 30;2020:6726017. doi: 10.1155/2020/6726017. eCollection 2020.
Loss and dilution of coagulation factors have been observed following multiple trauma. Timely recognition of reduced clotting factor activity might facilitate therapeutic action to restore normal coagulation function. This study investigates the potential role of some well-known trauma scores in predicting coagulation factor activity after multiple injuries. A dataset comprising the coagulation factor activities of 68 multiply injured adult patients was analyzed. The following trauma scores were evaluated: AIS, ISS, NISS, GCS, RTS, TRISS, RISC, and TASH score. To investigate the effect of trauma severity with respect to a single anatomic injury location, two groups according to the AIS (<3 vs. ≥3 points) were formed. Differences between these two groups were analyzed for five different body regions (head, thorax, abdomen, pelvis, extremities) using the Mann-Whitney -test. Spearman's rank correlation coefficient rho was calculated to reveal possible relationships between trauma scores and clotting factor activities. The analysis showed clearly reduced clotting factor activities with a significant reduction of FII (83 50%; = .021) and FV (83 46%; = .008) for relevant (AIS ≥ 3 points) pelvic injuries. In contrast, traumatic brain injury according to the AIS head or the GCS does not appear to lead to a significant decrease in coagulation factor activities. Furthermore, the other scores studied show at best a fair correlation with coagulation factor activity. In this context, the RTS score seems to be the most suitable. Additionally, the predictive value of the TASH score, which was specifically developed to predict the need for mass transfusion, was also limited in this study. We would like to explicitly point out that this is not a criticism of the trauma scores, since they were developed in a completely different context.
多发伤可导致凝血因子丢失和稀释。及时发现凝血因子活性降低可能有助于采取治疗措施恢复正常凝血功能。本研究旨在探讨一些著名创伤评分在预测多发伤后凝血因子活性方面的潜在作用。分析了包含 68 例多发伤成年患者凝血因子活性的数据集。评估了以下创伤评分：AIS、ISS、NISS、GCS、RTS、TRISS、RISC 和 TASH 评分。为了研究单一解剖损伤部位的创伤严重程度的影响，根据 AIS（<3 分与≥3 分）将两组患者分为两组。使用 Mann-Whitney U 检验分析这两组在五个不同身体部位（头部、胸部、腹部、骨盆、四肢）之间的差异。计算 Spearman 秩相关系数 rho，以揭示创伤评分与凝血因子活性之间的可能关系。分析表明，与骨盆相关的（AIS≥3 分）损伤的凝血因子 II（83 50%； =.021）和凝血因子 V（83 46%； =.008）活性明显降低。相比之下，根据 AIS 头部或 GCS 确定的创伤性脑损伤似乎不会导致凝血因子活性显著降低。此外，所研究的其他评分与凝血因子活性的相关性最好也只是中等。在这种情况下，RTS 评分似乎是最合适的。此外，本研究还发现，专门用于预测大量输血需求的 TASH 评分的预测价值也受到限制。我们想明确指出，这并不是对创伤评分的批评，因为它们是在完全不同的背景下开发的。
