Endo et al developed novel criteria for the "lethal triad" in acute trauma care. The authors are from multiple institutions in Japan.

Patient selection: age >= 18 years, acute trauma with ISS >= 16


Outcome: 28-day mortality


Conventional lethal triad:

(1) INR > 1.50

(2) pH < 7.2

(3) core body temperature < 35°C


Novel "lethal triad" - one or both of the "novel triad":

(1) fibrinolytic disorder with FDP > 90 microgram per mL (major criteria, method and reference range not given)

(2) both of the following (minor criteria):

(2a) acidosis with base excess < -3 mmol/L

(2b) hypothermia with core body temperature < 36°C



• The sensitivity was 81% and specificity 67%.

• The negative predictive value is 95% while the positive predictive value is 29%.

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