Chang R, et al. - A prospective observational study of adult trauma patients transported by helicopter was planned to describe clinically-evident coagulopathy (CC) among trauma patients. Compared to laboratory-based evidence of coagulopathy (LC), CC was rare. Researchers observed poor outcomes and impairment of both clotting factor and platelet-mediated coagulation components in association with CC.

Methods

• Adult trauma patients transported by helicopter from the scene to nine Level 1 trauma centers in 2015 were prospectively observed.
• Division of patients meeting predefined highest-risk criteria into CC+ (predefined as surgeon-confirmed bleeding from uninjured sites or injured sites not controllable by sutures) or CC- was performed.
• A mixed-effects, Poisson regression with robust error variance was used to test the hypothesis that abnormalities on rapid thrombelastography (r-TEG) and international normalized ratio (INR) were independently associated with CC+.

Results

• Researchers identified 1,019 highest-risk patients.
• Among these, CC+ (n=41, 4%) patients were more severely injured (median ISS 32 vs 17), had evidence of LC on r-TEG and INR, received more transfused blood products at 4 hours (37 vs 0 units), and had greater 30-day mortality (59% vs 12%) than CC- (n=978, 96%).
• Observations revealed the overall LC incidence of 39%.
• In those with and without LC, 30-day mortality was 22% vs 9%.
• In two separate models, r-TEG K-time >2.5 min (RR 1.3, 95% CI 1.1-1.7), r-TEG mA <55 mm (RR 2.5, 95% CI 2.0-3.2), platelet count <150 x 10⁹/L (RR 1.2, 95% CI 1.1-1.3), and INR >1.5 (RR 5.4, 95% CI 1.8-16.3) seemed to have independent association with CC+.
• As too few patients underwent both r-TEG and INR, a combined regression model was not generated.