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Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum.

Publication ,  Journal Article
MacLeod, JBA; Winkler, AM; McCoy, CC; Hillyer, CD; Shaz, BH
Published in: Injury
May 2014

INTRODUCTION: Newer studies have hypothesised about a coagulopathy that occurs early after trauma, early trauma induced coagulopathy, ETIC, and is defined by an elevated admission prothrombin time (PT). Also, referred to by some authors as acute traumatic coagulopathy, it has been most often studied in cohorts of severely injured or hypotensive patients. However, we wanted to prospectively investigate ETIC in a large all-comers cohort to confirm its prevalence across the entire spectrum of injury, to evaluate its risk pattern and to determine a possible relationship to reduced survival. METHODS: We conducted a prospective cohort study at a Level I trauma centre from July 15, 2008 to November 15, 2009. Demographics, injury mechanism, time from injury and to hospital arrival, fluid and blood administration and vital signs were collected at hospital arrival and to the time of first blood sample collection for all patients admitted for 24h or longer. Our primary outcome was the incidence of mortality by the 28th hospital day, referred to as 28 day in-hospital mortality. RESULTS: 701 patients were included in the final study cohort. There was 75.3% male, 25.7% penetrating, with a mean age of 39 years. The overall mortality was 7.3%. ETIC occurred in 114 patients (16.3%) and was found to be independently associated with death (odds of death (per 0.10s increase in PT): 1.10, p=0.001). ETIC patients, as a group, were more severely injured, had more hypotension and head injury and used more crystalloid and blood products than non-ETIC patients. However, even mildly injured patients, who had an ISS<16, normal RTS score, and no fluid resuscitation, had an ETIC prevalence of 11.7% (11/94). CONCLUSIONS: ETIC is an early, primary post-injury coagulopathy that occurs in 16.3% of admitted trauma patients. It is associated with an increase in mortality, even when controlling for crystalloids, vital signs, injury severity and head injury. It can also be found in approximately 11% of mildly injured patients (patients without physiological derangement or blood product administration). Therefore, further elucidation of ETIC is strategic to impacting trauma patient outcome.

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Published In

Injury

DOI

EISSN

1879-0267

Publication Date

May 2014

Volume

45

Issue

5

Start / End Page

910 / 915

Location

Netherlands

Related Subject Headings

  • Wounds, Penetrating
  • Wounds, Nonpenetrating
  • Treatment Outcome
  • Trauma Centers
  • Survival Analysis
  • Resuscitation
  • Prospective Studies
  • Prevalence
  • Orthopedics
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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MacLeod, J. B. A., Winkler, A. M., McCoy, C. C., Hillyer, C. D., & Shaz, B. H. (2014). Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum. Injury, 45(5), 910–915. https://doi.org/10.1016/j.injury.2013.11.004
MacLeod, Jana B. A., Anne M. Winkler, Cameron C. McCoy, Christopher D. Hillyer, and Beth H. Shaz. “Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum.Injury 45, no. 5 (May 2014): 910–15. https://doi.org/10.1016/j.injury.2013.11.004.
MacLeod JBA, Winkler AM, McCoy CC, Hillyer CD, Shaz BH. Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum. Injury. 2014 May;45(5):910–5.
MacLeod, Jana B. A., et al. “Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum.Injury, vol. 45, no. 5, May 2014, pp. 910–15. Pubmed, doi:10.1016/j.injury.2013.11.004.
MacLeod JBA, Winkler AM, McCoy CC, Hillyer CD, Shaz BH. Early trauma induced coagulopathy (ETIC): prevalence across the injury spectrum. Injury. 2014 May;45(5):910–915.
Journal cover image

Published In

Injury

DOI

EISSN

1879-0267

Publication Date

May 2014

Volume

45

Issue

5

Start / End Page

910 / 915

Location

Netherlands

Related Subject Headings

  • Wounds, Penetrating
  • Wounds, Nonpenetrating
  • Treatment Outcome
  • Trauma Centers
  • Survival Analysis
  • Resuscitation
  • Prospective Studies
  • Prevalence
  • Orthopedics
  • Male