Acute Traumatic Coagulopathy in Iran; Incidence and Possible Risk Factors

Abstract

Introduction: Acute traumatic coagulopathy (ATC) is a disruption of hemostasis at the moment of impact and is associated with increased mortality. Without quickly available diagnostic tests, risk factors play an important role in identifying those at risk. We aim to determine the incidence of ATC and find its risk factors in a previously unreported population.

Methods: A retrograde analysis of records was done on all severe trauma patients at two major trauma centers in Tehran for whom a coagulation panel had been ordered on admission. Rate of ATC was determined with different definitions and association with outcome measures was analyzed. Association between risk factors and ATC was analyzed first in a cross-sectional manner and then using logistic regression via SPSS21 software.

Results: Overall 246 patients were included (88.2% male). PTratio>1.2 was seen in 11.4% and best predicted outcomes. ISS score>23 (P=0.001), abdominal Abbreviated Injury Score (AIS)>3 (P=0.003), BE more negative than -4 (P=0.019), PR in the ED>90 (P=0.041), pH<7.30 (P=0.043), and PR at the scene>90 (P=0.046) were found to be associated with the development of ATC. Of these abdominal AIS more than 3 (P=0.001), and BE more negative than -4 (P=0.011) were found to be independent predictors of ATC in logistic regression.

Conclusion: We determined the rate of ATC for the first time in a Middle Eastern country and found it to be closer to the lower margin of previously reported frequencies. Our findings also cement previous reports that both severe injury and hypoperfusion put patients at risk for ATC.