Evidence Browser: Source: SimmonsEtAl2011

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Publication:Mechanism of injury affects acute coagulopathy of trauma in combat casualties
Reference:

Simmons JW, White CE, Ritchie JD, Hardin MO, Dubick MA, Blackbourne LH. Mechanism of injury affects acute coagulopathy of trauma in combat casualties. J Trauma 2011;71(1 Suppl):S74-7.

Abstract:Background: Recent evidence suggests trauma involving total body tissue damage increases the acute coagulopathy of trauma (ACOT) by various mechanisms, especially in massive transfusion (MT). Our hypothesis was that MT patients injured by explosion will have a higher international normalization ratio (INR) at admission than MT patients injured by gunshot wound (GSW). Methods: A retrospective review was performed on US military injured in Operation Iraqi Freedom/Operation Enduring Freedom from March 2003 to September 2008, who received MT (? 10 red blood cells in 24 hours) and had an INR on admission. Two cohorts were created based on mechanism. Admission vital signs, labs, transfusion, and mortality data were compared. Results: Seven hundred fifty-one MT patients were identified. Four hundred fifty patients had admission INR and were injured by either GSW or explosion. Patients demonstrated similar injury severity scale and Glasgow Coma Scale. Patients injured by explosion presented with higher INR, greater base deficit, and more tachycardic than patients injured by GSW. Transfusion of blood products was similar between both groups. Conclusions: The primary finding of this study is that patients injured by explosion presented with a higher INR than those injured by GSW, even with similar injury severity scale. In addition, patients injured by explosion presented more tachycardic and with a greater base deficit. These findings support the theory that ACOT is affected by the amount of tissue injured. Further research is needed into the pathophysiology of ACOT because this may impact care of patients with total body tissue damage/hypoxia and improve the treatment of their coagulopathy while minimizing the attendant complications.
Publication Type:Human observational study
Low Risk of Bias:
  • Adjustment for confounding
  • Baseline characteristics of sample
  • Causative factors defined
  • Causative factors measured accurately
  • Coagulopathy appropriately defined
  • Representative sample from a relevant population
High Risk of Bias:
  • All eligible patients included
  • Eligibility criteria
Unclear Risk of Bias:
  • Coagulopathy assessed on arrival to hospital
Risk of Bias Score:6