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Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?

Abstract : Purpose It has been suggested to define the Trauma-induced coagulopathy (TIC) with a PTratio threshold of 1.20. We hypothesized that a more pragmatic classification would grade severity according to the PTratio (or corresponding ROTEM clotting time: EXTEM-CT), and that this would correlate better with the need for blood products (BP) and prognosis. Methods Retrospective analysis of prospectively collected data of 1076 severely injured patients admitted from 01/2011 to 12/2019 in a university hospital. To determine the number of TIC categories and the best PTratio or EXTEM-CT thresholds for mortality at 24-h, a modified Mazumdar approach was used. Multivariate regression analyses were done to describe the relationship between PTratio and ROTEM parameter subclasses with mortality. Results Three thresholds were, respectively, identified for PTratio (1.20, 1.90 and 3.00) and EXTEM-CT (90 s, 130 s, 200 s). The following categories were defined for PTratio: ≤ 1.20 (No TIC), 1.21–1.90 (Moderate TIC), 1.91–3.00 (severe TIC), > 3.00 (major TIC); and for EXTEM-CT: < 91 s (no TIC), 91–130 s (moderate TIC), 131–200 s (severe TIC) and > 200 s (major TIC). We observed that when the PTratio (or EXTEM-CT) increased, mortality and BP requirements increased. After multiple adjustments, we observed that each subclass of PTratio and EXTEM-CT was independently associated with mortality at 24-h. Conclusion In this study, we have described a pragmatic classification of coagulopathy utilizing PTratio and EXTEM-CT where increasing severity was associated with prognosis and the amount of BP administered. This could allow clinicians to better predict the outcome and anticipate the need for blood products.
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Contributor : Laurie Fraticelli Connect in order to contact the contributor
Submitted on : Sunday, February 6, 2022 - 10:20:37 AM
Last modification on : Monday, February 7, 2022 - 3:31:31 AM

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Jean-Stéphane David, Arnaud Friggeri, Charles-Hervé Vacheron, Pierre Bouzat, Laurie Fraticelli, et al.. Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?. European Journal of Trauma and Emergency Surgery, Springer Verlag, 2022, ⟨10.1007/s00068-022-01882-6⟩. ⟨hal-03559164⟩

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