David et al identified prehospital factors associated with coagulopathy of a trauma patient. These can help to identify a patient who may benefit from more aggressive resuscitation. The authors are from Lyon-Sud Hospital, University of Lyon, and Edouard Herriot Hospital in France.
Patient selection: trauma victim
Outcome: trauma-induced coagulopathy at admission by 3 models
Criteria for coagulopathy - one or more of the following:
(1) PT ratio > 1.5
(2) platelet count < 100,000 per µL
(3) plasma fibrinogen < 1.5 g/L (< 150 mg/dL)
Prehospital predictors from multivariate analysis in all 3 models:
(1) ISS (injury severity score) > 34 (odds ratio 1.1)
(2) prehospital fluid administration > 1,000 mL (odds ratios from 2.5 to 3.3)
(3) vasopressor administration (norepinephrine, odds ratio 3.1 to 4.1)
Predictors from 1 of 3 models:
(1) shock index (systolic blood pressure divided by heart rate) > 0.9 (odds ratio 3.2)
(2) resuscitation outcome consortium (ROC) criteria (odds ratio 2.5)
where:
• The ROC criteria used systolic blood pressure and heart rate, which are used in the shock index. For the implementation the shock index will be used.
