Coagulopatía asociada al trauma en la Unidad de Cuidados Intensivos

Abstract

Introduction: trauma is a global health problem. Trauma-associated coagulopathy constitutes a severe and multifactorial complication whose diagnosis is controversial. Objectives: to assess the incidence of trauma-associated coagulopathy, the factors associated to the development of this condition and their impact on prognosis in a series of trauma patients admitted into the intensive care unit of our hospital.Method: prospective study of all patients admitted to the ICU with a diagnosis of acute trauma. Trauma-associated coagulopathy was defined according to classical laboratory parameters, when it complies with one of the following:  International normalized ratio (INR) greater than 1.3, thrombocytopenia smaller than 100000/mm3, and/or aPTT greater than 38 seconds. Continuous variables were expressed as the average ± standard deviation. The chi square analysis, Fisher exact test and binary logistic regression were performed, p < 0,05 being considered significant.Results: 103 patients were analysed, average age was 33 years old and they were mostly male. Trauma-associated coagulopathy was found in 42 patients (40.8 %), and it was seen in most patients at the time they were hospitalized. Risk factors of trauma-associated coagulopathy were the following: severity upon hospitalization, shock, hypoperfusion, acidosis, massive transfusion, significant bleeding (univariate analysis); penetrating trauma and multi-organ dysfunction (multivariate analysis). No significant association between trauma- associated coagulopathy and mortality was found.Conclusions: the study presents the first report on this topic in our country. Trauma associated coagulopathy is rather common in our population and it is seen upon hospitalization. This condition is related to severity and the kind of trauma. Early diagnosis is essential in the handling of patients with severe trauma.