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The Study of Coagulation Parameters in Polytrauma Patients and Their Effects on Outcome
Gururaj N Puranik1, Tanvi Y P Verma1, Gopal A Pandit1
1Dr. V.M. Government Medical College, Solapur, India.
Insights
Coagulopathy affects nearly 60% of major trauma patients, significantly impacting survival. Early coagulation screening, especially prothrombin time (PT), is crucial for predicting outcomes in polytrauma cases.
Area of Science:
- Trauma Care
- Hematology
- Public Health
Background:
- Trauma mortality is a significant public health concern, particularly in the 5-44 age group.
- Limited data exists on polytrauma coagulopathy in developing nations.
- This study addresses the knowledge gap by investigating coagulation in polytrauma patients.
Purpose of the Study:
- To investigate coagulation parameters in polytrauma patients.
- To correlate coagulation findings with patient prognosis.
- To assess the utility of initial coagulation profiles in predicting outcomes.
Main Methods:
- A prospective study conducted over 20 months in a tertiary care center.
- Included polytrauma patients (Injury Severity Score ≥ 15) with multi-system injuries.
- Coagulation tests (BT, CT, CBC, PT, aPTT, TT, D-dimer) performed within 2 hours of sample collection.
Main Results:
- The incidence of coagulopathy was 59.86% among polytrauma patients.
- Prolonged prothrombin time (PT), activated partial thromboplastin time (aPTT), and thrombin time (TT) were observed in coagulopathic patients.
- Prothrombin time (PT) emerged as a significant predictor of mortality.
Conclusions:
- A substantial number of polytrauma patients exhibit coagulopathy.
- Initial coagulation profiles are valuable for predicting outcomes in severe trauma.
- Emphasizes early screening for coagulopathy in polytrauma patients, especially in developing countries.
Background:
Mortality from trauma remains a major public health issue as it is the leading cause of death in persons aged 5 - 44 years. There is a dearth of information on polytrauma from developing countries such as ours. Hence, this topic was studied at our institute. The objective is to study the coagulation parameters in polytrauma patients at our institute and to correlate the findings with the prognosis.
Methods:
A prospective study was carried out in the department of pathology in a tertiary care center, during a period of 20 months from December 2012 to July 2014. All the polytrauma patients (injury severity score (ISS) ≥ 15) with injuries to head and neck, face, thorax, abdomen, extremities and external (skin) were included. Sampling was done within 20 min of arrival during primary survey of the patient. Screening tests like bleeding time (BT) and clotting time (CT) were carried out bedside. Other tests carried out were complete blood count (CBC), prothrombin time (PT), activated thromboplastin time (aPTT), thrombin time (TT) and D-dimer assay. Tests were carried out on fresh samples within 2 h of collection.
Results:
The incidence of coagulopathy was 59.86%. There was significant prolongation of PT, aPTT and TT in those patients who developed coagulopathy. PT was found to be a stronger predictor of mortality among polytrauma patients.
Conclusion:
A significant proportion of polytrauma patients were coagulopathic. Initial coagulation profile is very useful in predicting outcomes for major polytrauma patients. This study emphasizes the importance of early suspicion and basic screening for coagulopathy in polytrauma patients in developing countries.
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