Mechanistic Determinants of the Acute Coagulopathy of Trauma (ACoT) in Patients Undergoing Emergency Surgery,

Abstract

Abstract 3319 Introduction:Acute coagulopathy of trauma (ACoT) is a highly lethal phenomenon whose mechanisms have yet to be clearly defined. While likely multi-factorial, it has been reported to only occur in the presence of blunt injury. The purpose of this study was to identify variables that might influence or contribute to the early development of ACoT. Methods:Retrospective review of all patients admitted to a Level 1 trauma center 01/2004–12/2009 who underwent emergent laparotomy. Emergent laparotomy was defined as laparotomy performed within two hours of admission. ACoT(+) was defined as arrival INR >= 1.5, while ACoT(−) was defined as arrival INR<1.5. Univariate and multivariate analyses performed. Primary outcome was the identification of those factors predicting the presence of ACoT on admission. Results:1218 patients were included, 337 (27%) presented with ACoT(+), 881 (73%) did not. The groups had similar demographics and pre-hospital and ED fluids. Arrival base deficit (median 8.5 vs. 4.0) and ISS (25 vs. 16) were higher in ACoT(+) as were intra-operative RBC (median 4 vs. 0 U) and plasma (3 vs. 0 U); all p<0.05. 40% of ACoT(+) patients sustained penetrating injury. Six-hour (12% vs. 1%), 24-hour (15% vs. 1%), and 30-day (23% vs. 4%) mortality were significantly greater in ACoT(+); all p<0.001. Linear regression found INR values independently associated with arrival base deficit (p<0.001) but not ISS. Controlling for age, gender, mechanism of injury, and pre-hospital resuscitation, multiple logistic regression demonstrated that arrival base deficit was an independent predictor of developing ACoT.Odds ratio95% C.I.p-valueArrival base value0.9220.870, 0.9780.007Injury severity score1.051.025, 1.083<0.001Pre-hospital SBP, mmHg0.980.968, 0.9910.001 Conclusion:The current study found ACoT independently associated with metabolic (base deficit), physiologic (blood pressure) and anatomic insults (ISS). Attempts to address ACoT should focus on correcting each of these components. Moreover, contrary to prior data, 40% of ACoT(+) patients sustained penetrating mechanism. Disclosures:No relevant conflicts of interest to declare.