EARLY POST-TRAUMATIC COAGULOPATHY IN MULTIPLY INJURY

There is increasing evidence for acute traumatic coagulopathy in multiply injured patients occurring prior to emergency room (ER) admission but detailed information is insufficient. The present study aimed to evaluate the frequency of acute post-traumatic coagulopathy on ER admission in patients with multiply injury. A retrospective analysis using the German Trauma Registry database including 17.200 multiple injured patients was conducted to determine to what extent clinically relevant coagulopathy has already been established upon ER admission, and whether its presence was associated with impaired outcome and mortality. 8.724 patients with complete data sets were screened. Coagulopathy upon ER admission was present in 2.989 (34.2%) of all patients. Males were more affected than females (72.5% vs. 27.5%) and in 96% the trauma mechanism was blunt. The mean ISS score in the coagulopathy group was 30 ± 15, while trauma patients without coagulopathy upon ER admission generally presented with lower ISS scores (mean ISS 21 ± 12; p < 0.001). 29% of patients with coagulopathy developed multi organ failure (p < 0.001). Early in-hospital mortality (< 24 hrs) was 13% in patients with coagulopathy (p < 0.001) and overall in-hospital mortality totalled 28% (p < 0.001). In summary, there is a high frequency of established coagulopathy in multiply injury upon ER admission. The presence of early traumatic coagulopathy was associated with injury severity and impaired outcome.