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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?

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

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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Availability of data

The data that support the findings of this study are available on request from the corresponding author, [JSD].

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department d’Anesthésie Réanimation, Groupe Hospitalier Sud, Hospices Civils de Lyon, 69495, Pierre Benite, France

    Jean-Stéphane David, Arnaud Friggeri & Charles-Hervé Vacheron

  2. Research on Healthcare Performance (RESHAPE), INSERM U1290, University Claude Bernard Lyon 1, Lyon, France

    Jean-Stéphane David

  3. Department of Anesthesia and Intensive Care, Department of Anaesthesiology and Intensive Care Medicine, Grenoble-Alpes University Hospital, 38000, Grenoble, France

    Pierre Bouzat

  4. RESUVAL Trauma Network, Lucien Hussel General Hospital, Vienne, France

    Laurie Fraticelli & Clément Claustre

  5. EA 4129 P2S Parcours Santé Systémique, University Claude Bernard Lyon 1, 69008, Lyon, France

    Laurie Fraticelli & Clément Claustre

  6. Department of Traumatology and Orthopedic Surgery, Cologne-Merheim Medical Center, University of Witten/Herdecke, 200, 51109, Cologne, Germany

    Marc Maegele

  7. Division of Trauma and Critical Care, Department of Surgery, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA

    Kenji Inaba

Authors
  1. Jean-Stéphane David
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  2. Arnaud Friggeri
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  3. Charles-Hervé Vacheron
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  4. Pierre Bouzat
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  5. Laurie Fraticelli
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  6. Clément Claustre
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  7. Marc Maegele
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  8. Kenji Inaba
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Contributions

JSD conceived the study and designed the trial. CC and LF supervised data collection. JSD, LF and CC managed the data. CC and CHV provided statistical advice on study design and analyzed the data. PB, AF, KI and MM did a critical review of the manuscript. JSD drafted the manuscript, and all authors contributed substantially to its revision. JSD takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Jean-Stéphane David.

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Conflict of interest

JS David and P Bouzat received honoraria for lectures, advisory boards (LFB, Les Ullis, France; Werfen/TEM International, Le pré St Germain, France), M Maegele received honoraria for lectures, speakers’ bureaus, advisory boards and research projects from Astra Zeneca, Bayer, Biotest, CSL Behring, IL-Werfen/TEM International and LFB Biomedicaments. No conflict of interest for the other authors.

Ethics approval

The regional emergency network RESUVAL obtained official approval from the Commission Nationale Informatique et Liberte (DE 2012-059), the CCTIRS (Comité consultatif sur le traitement de l'information en matière de recherche) and the Institutional review board (02/2020).

Informed consent

Written informed consent was not required and all patients (or their next of kin) were provided with information about the registry.

Supplementary Information

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Supplementary file1 (DOCX 18 KB)

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David, JS., Friggeri, A., Vacheron, CH. et al. Is it possible to improve prediction of outcome and blood requirements in the severely injured patients by defining categories of coagulopathy?. Eur J Trauma Emerg Surg 48, 2751–2761 (2022). https://doi.org/10.1007/s00068-022-01882-6

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  • DOI: https://doi.org/10.1007/s00068-022-01882-6

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