The prevalence of abnormal results of conventional coagulation tests on admission to a trauma center

Authors

  • John R. Hess,

    1. From the Departments of Pathology, Trauma Anesthesia, and Trauma Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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  • Allison L. Lindell,

    1. From the Departments of Pathology, Trauma Anesthesia, and Trauma Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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  • Lynn G. Stansbury,

    1. From the Departments of Pathology, Trauma Anesthesia, and Trauma Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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  • Richard P. Dutton,

    1. From the Departments of Pathology, Trauma Anesthesia, and Trauma Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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  • Thomas M. Scalea

    1. From the Departments of Pathology, Trauma Anesthesia, and Trauma Surgery, University of Maryland School of Medicine, Baltimore, Maryland.
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John R. Hess, MD, MPH, FACP, FAAAS, Professor of Pathology and Medicine, c/o Blood Bank, N2W50a, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD 21201; e-mail: jhess@umm.edu.

Abstract

BACKGROUND: Several groups have reported that a fraction of severely injured patients have abnormal coagulation tests at presentation to trauma centers, even in the absence of significant crystalloid resuscitation. These patients have high mortality, but their prevalence in trauma populations is not clear from the reports.

STUDY DESIGN AND METHODS: Records of all patients admitted to a large urban trauma center during 2000 through 2006 were searched for early measures of common coagulation tests and in-hospital mortality.

RESULTS: Abnormal coagulation tests were increasingly frequent with increasing injury severity, ranging from 5 to 43 percent for the prothrombin time as the injury severity scores (ISSs) increased from 5 to more than 45 and 4 to 18 percent for platelet counts of less than 150 × 109 per L. Abnormal coagulation tests were associated with excess mortality even below conventional transfusion triggers and this was especially true for the partial thromboplastin time.

CONCLUSIONS: Abnormal coagulation tests are common in severely injured patients. Even in the moderately injured, they are associated with higher mortality.

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