Early coagulopathy predicts mortality in trauma.

Area of Science:

• Trauma research
• Hematology
• Critical care medicine

Background:

• Coagulopathy and hemorrhage are significant contributors to trauma mortality.
• The precise relationship between initial prothrombin time (PT) and partial thromboplastin time (PTT) and mortality risk remains unclear.
• Understanding these relationships is vital for effective trauma patient management.

Purpose of the Study:

• To evaluate the predictive value of initial coagulopathy parameters for trauma-related mortality.
• To determine if PT and PTT are independent predictors of mortality in trauma patients.
• To quantify the increased mortality risk associated with abnormal PT and PTT.

Main Methods:

• Prospective data collection from a Level I trauma center.
• Logistic regression analysis of PT, PTT, platelet count, and relevant confounders.
• Inclusion of 7638 trauma patients with complete data for final analysis.

Main Results:

• A substantial prevalence of coagulopathy was observed early post-injury (28% abnormal PT, 8% abnormal PTT).
• Abnormal PT and PTT were significantly associated with increased all-cause mortality (p < 0.001).
• PT and PTT remained independent predictors of mortality in multivariate analysis, unlike platelet count.

Conclusions:

• Coagulation abnormalities are common early after trauma and are independent predictors of mortality.
• An abnormal initial PT increases the adjusted odds of dying by 35%.
• An abnormal initial PTT significantly increases the adjusted odds of dying by 326%.