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Published on: August 4, 2023
Prediction of trauma-induced coagulopathy in early polytrauma: a prospective cohort study
Bo Li1, Lichun Liu2, Xiaoli Feng1
1General Hospital, First Clinical Medical College, Ningxia Medical University, Yinchuan, China.
Background:
Traumatic induced coagulopathy (TIC) is a key factor affecting the prognosis of patients with polytrauma. Early identification of patients at high risk for TIC and timely initiation of damage-control interventions are crucial. This study aims to develop and validate a predictive model for individualized estimation of TIC risk based on clinical characteristics and routine laboratory indicators.
Methods:
This prospective cohort study included 183 adult patients, aged 18 to 85 years, with confirmed multiple injuries who presented to the emergency department of our hospital between July 1, 2023, and December 31, 2024. Patients were divided into a TIC group (n = 123) and a non-TIC group (n = 60) according to the occurrence of TIC. Candidate predictors were screened using univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariable logistic regression to construct the model. Model performance was comprehensively evaluated using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA).
Results:
Four core predictors were ultimately identified: emergency surgery, pH value, red blood cell count (RBC), and Injury Severity Score (ISS).The model demonstrated good discriminative ability (AUC = 0.903, 95% CI: 0.858-0.948).The optimal cut-off value determined by the Youden index was 0.651, with a sensitivity of 81.3% and a specificity of 86.7%.The calibration curve showed high agreement between predicted and observed risks. Decision curve analysis further indicated that the model provided favorable clinical net benefit across a wide range of threshold probabilities.
Conclusion:
The predictive model developed in this study showed promising ability to estimate individualized TIC risk in patients with polytrauma and may serve as an effective tool to optimize the allocation of medical resources and facilitate early diagnosis and intervention for traumatic coagulopathy.
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