COAGULATION PARAMETERS AS PROGNOSTIC FACT ORS IN POLYTRAUMATIZED PATIENTS - CAN CLINICAL FINDINGS BE OF EARLY DIAGNOSTIC HELP

Introduction: Polytraumatized patients develop complex changes in bloo d coagulation and fibrinolysis even before their arrival at the emerge ncy room (ER). Hemostaseological parameters (i.e. antithrombine 3, alp ha-2-antiplasmine, D-dimers) obtained upon admission however, permit a dvance differentiation of later mortality vs. survival and of possible future secondary organ failure with varying specification. Objectives : Which clinical findings enable to identify such patients eary in the ER even when no specialized hemostaseological laboratory is available ? Material and methods: a) Prospective study of 40 polytraumatized adu lts upon arrival at the hospital; b) Blood sampling at the earliest po ssible time during takeover in the ER; c) Injury Severity Score (ISS) for descriptive purposes; d) Evaluation of the prehospital emergency p hysician's records in regard to respiratory therapy, fluid resuscitati on, and arterial blood pressure; e) Statistics; Wilcoxon test, Spearma n correlation coefficient. Results: All 40 patients (m:f = 28:12; mean age: 36 (SD: 16.6) years; mean ISS: 34.7 (SD: 11.4)) displayed advanc ed disseminated intravascular coagulation with secondary hyperfibrinol ysis upon arrival in the ER. The amount of deviation from the hemostas eological norm could not be derived from either the correlation of the typical activated parameters of coagulation of fibrinolysis with the ISS or the analysis of the separate injuries. On the other hand the su bgroup of patients displaying a systolic blood pressure of less than 1 00 mmHg at the site of the accident or upon arrival at the ER all had significantly lower antithrombine 3, protein C, and alpha-2-antiplasmi ne activities as well as increased concentrations of specific reaction products resulting from activated coagulation (thrombine-antithrombin e 3-complex) and of fibrinolysis (D-dimers). Conclusion: In our study patients with multiple injuries displaying a systolic blood pressure o f less than 100 mmHg either at the scene of the accident or upon arriv al in the ER showed coagulation values which by other investigators we re regarded as a sign of potential secondary organ failure or death.