PREDICTING LIFE-THREATENING COAGULOPATHY IN THE MASSIVELY TRANSFUSED TRAUMA PATIENT - HYPOTHERMIA AND ACIDOSES REVISITED

Background. Recalcitrant coagulopathy ''the bloody vicious cycle,'' pr oduces the majority of deaths after torso trauma, A model predicting t his life-threatening complication may facilitate clinical decision-mak ing. Methods, We prospectively analyzed patients > 15 Sears old who re ceived a massive transfusion (> 10 units of packed red blood cells (PR BC)/24 h) over a 2-year period. Excluding massive head injuries and pr e-existing disease, the 58 study patients had a mean age = 35.4 years, injury Severity Score (ISS) = 30.6, and PRBC = 24.2 units/24 h, Resul ts, Defined as prothrombin time of two times that of normal laboratory controls and partial thromboplastin time as two times that of normal laboratory controls, 27 patients (47%) developed life-threatening coag ulopathy. Using a multiple logistic regression model, the four signifi cant risk factors (with odds ratio) were (1) pH < 7.10 (12.3), (2) tem perature < 34 degrees C (8.7), (3) ISS > 25 (7.7), and (4) systolic bl ood pressure < 70 mm Hg (5.8), The conditional probability of developi ng coagulopathy was ISS, 25 + systolic blood pressure < 70 mm Hg = 39% , ISS > 25 + temperature < 34 degrees C = 49%, ISS > 25 + pH < 7.10 = 49%; with all four risk factors the incidence was 98%, Conclusion. Pos tinjury life-threatening coagulopathy in the seriously injured requiri ng massive transfusion is predicted by persistent hypothermia and prog ressive metabolic acidosis.