Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients

Maegele, Marc; Lefering, Rolf; Yucel, Nedim; Tjardes, Thorsten; Rixen, Dieter; Paffrath, Thomas; Simanski, Christian; Neugebauer, Edmund; Bouillon, Bertil; The AG Polytrauma of the German Trauma Society (DGU),

doi:10.1016/j.injury.2006.10.003

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Volume 38, Issue 3 , Pages 298-304, March 2007

Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients

Marc Maegele
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
- Corresponding author. Tel.: +49 221 989 57 0; fax: +49 221 989 57 21.
Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Nedim Yucel
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Thorsten Tjardes
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Dieter Rixen
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Thomas Paffrath
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Christian Simanski
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Edmund Neugebauer
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
Bertil Bouillon
- Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center (CMMC), Ostmerheimerstr. 200, D-51109 Cologne, Germany
The AG Polytrauma of the German Trauma Society (DGU)

Accepted 10 October 2006.

Summary

Background

There is increasing evidence for acute traumatic coagulopathy occurring prior to emergency room (ER) admission but detailed information is lacking.

Patients and methods

A retrospective analysis using the German Trauma Registry database including 17,200 multiple injured patients was conducted to determine (a) to what extent clinically relevant coagulopathy has already been established upon ER admission, and whether its presence was associated (b) with the amount of intravenous fluids (i.v.) administered pre-clinically, (c) with the magnitude of injury, and (d) with impaired outcome and mortality. Eight thousand seven hundred and twenty-four patients with complete data sets were screened.

Results

Coagulopathy upon ER admission as defined by prothrombin time test (Quick's value) <70% and/or platelets <100,000μl⁻¹, was present in 34.2% of all patients. There was an increasing incidence for coagulopathy with increasing amounts of i.v. fluids administered pre-clinically. Coagulopathy was observed in >40% of patients with >2000ml, in >50% with >3000ml, and in >70% with >4000ml administered. Ten percentage of patients presented with clotting disorders although pre-clinical resuscitation was limited to 500ml of i.v. fluids maximum. The mean ISS score in the coagulopathy group was 30 (S.D. 15) versus 21 (S.D. 12) (p<0.001). Twenty-nine percentage of patients with coagulopathy developed multi organ failure (p<0.001). Early in-hospital mortality (<24h) was 13% in patients with coagulopathy (p<0.001) and overall in-hospital mortality totalled 28% (p<0.001).

Conclusion

There is a high frequency of established coagulopathy in multiple injury upon ER admission. The presence of early traumatic coagulopathy was associated with the amount of intravenous fluids administered pre-clinically, magnitude of injury, and impaired outcome.

Keywords: Coagulopathy, Resuscitation, Injury severity score, Outcome, Mortality