Abstract
Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed, but none are in widespread use. This systematic review aimed to identify and assess accuracy of prediction tools for ATC. Materials and Methods: A search of OVID Medline and Embase was performed for articles published between January 1998 and February 2018. We searched for prognostic and predictive studies of coagulopathy in adult trauma patients. Studies that described stand-alone predictive or associated factors were excluded. Studies describing prediction of laboratory-diagnosed ATC were extracted. Performance of these tools was described. Results: Six studies were identified describing four different ATC prediction tools. The COAST score uses five prehospital variables (blood pressure, temperature, chest decompression, vehicular entrapment and abdominal injury) and performed with 60% sensitivity and 96% specificity to identify an International Normalised Ratio (INR) of >1.5 on an Australian single centre cohort. TICCS predicted an INR of >1.3 in a small Belgian cohort with 100% sensitivity and 96% specificity based on admissions to resuscitation rooms, blood pressure and injury distribution but performed with an Area under the Receiver Operating Characteristic (AUROC) curve of 0.700 on a German trauma registry validation. Prediction of Acute Coagulopathy of Trauma (PACT) was developed in USA using six weighted variables (shock index, age, mechanism of injury, Glasgow Coma Scale, cardiopulmonary resuscitation, intubation) and predicted an INR of >1.5 with 73.1% sensitivity and 73.8% specificity. The Bayesian network model is an artificial intelligence system that predicted a prothrombin time ratio of >1.2 based on 14 clinical variables with 90% sensitivity and 92% specificity. Conclusions: The search for ATC prediction models yielded four scoring systems. While there is some potential to be implemented effectively in clinical practice, none have been sufficiently externally validated to demonstrate associations with patient outcomes. These tools remain useful for research purposes to identify populations at risk of ATC.
Highlights
Injury is a leading cause of death in the young and middle-aged [1], and uncontrolled haemorrhage is responsible for many of these deaths
Is by conventional laboratory coagulation tests, which anecdotally take about 45 min to return, or viscoelastic measures of coagulation, which are not available in all centres. During this time, worsening coagulopathy may contribute to ongoing shock, leading to a vicious cycle and specific treatment should ideally be started towards prevention and early management of acute traumatic coagulopathy (ATC) [6]
We identified an additional 9 records during text-mining
Summary
Injury is a leading cause of death in the young and middle-aged [1], and uncontrolled haemorrhage is responsible for many of these deaths. Diagnosis of ATC is by conventional laboratory coagulation tests, which anecdotally take about 45 min to return, or viscoelastic measures of coagulation, which are not available in all centres. During this time, worsening coagulopathy may contribute to ongoing shock, leading to a vicious cycle and specific treatment should ideally be started towards prevention and early management of ATC [6]. Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. We searched for prognostic and predictive studies of coagulopathy in adult trauma patients. Studies that described stand-alone predictive or associated factors were excluded.
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