Coagulation Disorders And Mortality In Burn Injury: A Systematic Review

Even though coagulopathy is a familiar entity in trauma, its relationship to burn injury remains unclear. Literature appears inconsistent as to the conclusions of the use of coagulation assays, either routine methods or newer viscoelastic coagulation assays (VCAs), thromboelastography (TEG) and rotational thromboelastometry (ROTEM), for prediction of patients' coagulation status and mortality. The use of diagnostic assays as mortality markers will be of great importance, since they would recognize at early stages patients with great medical demands and objectify burn injury severity. The aim of this study was to review the literature and evaluate burn patients' characteristics and coagulation markers in the early post burn period. The secondary outcome was to investigate the role of different coagulation assays in mortality prognosis. Literature search was performed using PubMed, ScienceDirect, Wiley Online Library, Google Scholar, Proquest Dissertation and Theses Global, Scopus and Cochrane Library databases. All types of articles referring to adults with any type of burn injury admitted in the first 24h assessing coagulation and mortality were included. PRISMA guidelines ensured the evidence-based process. Eleven studies met the eligibility criteria. This review demonstrated the indubitable relationship of coagulopathy with burn injury and its significant impact on mortality. The rapid and dynamic process of coagulation makes standard coagulation assays unable to detect short-lived haemostatic changes. More susceptible markers such as VCAs need to be applied to the routine assessment of burn patients in order to obtain an overview on coagulopathy and standardize the gained knowledge.