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Record number:
1192
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
Patients with torso trauma were prospectively analyzed. Patients aged more than 15 years who received a massive transfusion , i.e. more than 10 units of packed red blood cells/24 h. Twenty seven of 58 (47%) developed coagulopathy.
Time to detection:
within 24 hours of hospitalization
Alerting signals, symptoms, evidence of occurrence:
Prospectively analyzed patients aged more than 15 years, who received a massive transfusion (> 10 units of packed red blood cells/24 h) over a 2-year period. Excluding massive head injuries and pre-existing disease, the 58 study patients had a mean age of 35.4 years, Injury Severity Score (ISS) = 30.6, and PRBC = 24.2 units/24 h. Results: Defined as prothrombin time of two times that of normal laboratory controls and partial thromboplastin time as two times that of normal laboratory controls, 27 patients (47%) developed life-threatening coagulopathy.
Demonstration of imputability or root cause:
Using a multiple logistic regression model, the four significant risk factors (with odds ratio) were (1) pH < 7.10 (12.3), (2) temperature < 34 degrees C (8.7), (3) ISS > 25 (7.7), and (4) systolic blood pressure < 70 mm Hg (5.8). The conditional probability of developing coagulopathy was ISS > 25 + systolic blood pressure < 70 mm Hg = 39%, ISS > 25 + temperature < 34 degrees C = 49%, ISS > 25 + pH < 7.10 = 49%; with all four risk factors the incidence was 98%. Postinjury life-threatening coagulopathy in the seriously injured requiring massive transfusion is predicted by persistent hypothermia and progressive metabolic acidosis.
Imputability grade:
2 Probable
Groups audience:
Keywords:
Suggest new keywords:
hypothermia, prothrombin time, head injuries, Injury Severity Score (ISS), torso injury
Reference attachment:
Suggest references:
Cosgriff, N., Moore, E.E., Sauaia, A., Kenny-Moynihan, M., Burch, J.M. and Galloway, B (1997). Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma 42(5):857-61.