L. Lampl et al., COAGULATION PARAMETERS AS PROGNOSTIC FACT ORS IN POLYTRAUMATIZED PATIENTS - CAN CLINICAL FINDINGS BE OF EARLY DIAGNOSTIC HELP, Zentralblatt fur Chirurgie, 119(10), 1994, pp. 683-689
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.