Frequency of early coagulopathy in multiple injury: an analysis of 8724 patients from the German Trauma Registry

Introduction

There is increasing evidence for acute traumatic coagulopathy occurring prior to emergency room (ER) admission but detailed information is still insufficient.

Objective

To evaluate the frequency of traumatic coagulopathy on ER admission in patients with multiple injury.

Methods

Retrospective analysis using the German Trauma Registry database including 17,200 multiple injured patients 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.

Results

A total of 8724 patients with complete data sets were screened. Coagulopathy upon ER admission was present in 2989 (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). Twenty-nine percent of patients with coagulopathy developed multiorgan failure (P < 0.001). Early inhospital mortality (<24 hours) was 13% in patients with coagulopathy (P < 0.001) and overall inhospital mortality totalled 28% (P < 0.001).

Conclusion

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.