Does a Simple Blood Gas Analysis and the Clinical Impression Predict Trauma-Induced Coagulopathy?

Area of Science:

• Traumatology
• Emergency Medicine
• Clinical Pathology

Background:

• Trauma-induced coagulopathy (TIC) is a frequent complication in severely injured patients, significantly increasing morbidity and mortality rates.
• Early identification and management of TIC are crucial for improving patient outcomes.

Purpose of the Study:

• To investigate the association between blood gas parameters (hemoglobin [Hb] and base excess [BE]) and standard coagulation tests (SCTs) or rotational thrombelastometry (ROTEM).
• To determine the correlation between Hb/BE levels and the occurrence of TIC.
• To assess the predictive value of Hb/BE in conjunction with clinical presentation for TIC.

Main Methods:

• Utilized data from the TraumaRegister DGU database (2015-2022) for adult patients with Injury Severity Score ≥9.
• Analyzed correlations between Hb/BE levels and SCT/ROTEM parameters.
• Examined the relationship between Hb/BE levels and the incidence of TIC, considering clinical factors.

Main Results:

• TIC was observed in 17.2% of 68,996 patients.
• A strong correlation was identified between Hb/BE levels and SCT.
• Decreased Hb and BE levels were associated with an increased frequency of TIC; Hb <8 g/dL and BE < -6 mmol/L indicated TIC in over 60% of patients.
• Clinical indicators like low Glasgow Coma Scale, hypotension, significant fluid resuscitation, and severe injuries to multiple body regions were associated with TIC.

Conclusions:

• Approximately 17% of trauma patients present with TIC upon admission.
• Blood gas analysis parameters (Hb/BE) demonstrate significant correlations with standard coagulation tests.
• Combining Hb/BE levels with clinical assessment effectively predicts TIC in most trauma patients.