Association Between Fluid Resuscitation Volume Levels and Coagulopathy and Mortality Among Traumatic Patients with Shock

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Orapan Kongsap Chennet Phonphet

Abstract

This descriptive study aimed to explore the association between volume levels of intravenous fluid resuscitation and coagulopathy in trauma patients. A retrospective correlational design and the second data from the patient’s health records were used for data analysis. A total of 326 eligible traumatic patients admitted in Suratthani hospital from 1 January 2016 to 31 December 2016 were recruited into the study. The instruments used for data collection were the record for volume of fluid resuscitation and laboratory test for blood clotting. Coagulopathy was defined by platelet counts <100,000 /uL and/or prothrombin time (PT) >13.3 second and/or activated partial thromboplastin time (aPTT) >60 seconds and/or an international normalized ratio (INR) >1.2. Data were analyzed by using frequency, percentage, mean, standard deviation t-test and chi-square test. This descriptive study aimed to explore the association between volume levels of intravenous fluid resuscitation and coagulopathy in trauma patients. A retrospective correlational design and the second data from the patient’s health records were used for data analysis. A total of 326 eligible traumatic patients admitted in Suratthani hospital from 1 January 2016 to 31 December 2016 were recruited into the study. The instruments used for data collection were the record for volume of fluid resuscitation and laboratory test for blood clotting. Coagulopathy was defined by platelet counts <100,000 /uL and/or prothrombin time (PT) >13.3 second and/or activated partial thromboplastin time (aPTT) >60 seconds and/or an international normalized ratio (INR) >1.2. Data were analyzed by using frequency, percentage, mean, standard deviation t-test and chi-square test.



The findings of this study showed that the most of the patients were men 75.5% (n=246), age between 15-82 years, an average age of 34.84 years (SD=15.14), no comorbidity 95.8% (n=312). All of the patients had not history of using drugs or coagulopathy medication, and 99.7% of them (n=325) were referred from a primary healthcare service. Coagulopathy rate was 44.2% (n=144). It can be concluded, therefore, that the volume level of fluid resuscitation was significantly associated with coagulopathy (χ2=57.27, p= .000) and mortality (χ2=47.50, p= .000) in traumatic patients with shock.

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References

1. Wafaisade A, Wutzler S, Lefering R, et al. Drivers of acute coagulopathy after sever trauma: A multivariate analysis of 1987 patients. Emerg Med J. 2010; 27: 934-9. doi: 10.1136/emj.2009.088484.

2. Ruzi C, Andresen M. Treatment of acute coagulopathy associated with trauma. ISRN Crit Care. 2013; 201: 1-7.

3. Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, et al. Early coagulopathy in multiple injury: An analysis from the German Trauma Registry on 8724 patients. Injury. 2007; 38: 298-304. doi: 10.1016/j.injury.2006.10.003

4. Cheddie S, Muckart DJ, Hardcastle TC. Base deficit as an early marker of coagulopathy in trauma. S Afr J Surg. 2013; 51(3): 88-90. doi: 10.7196/sajs.1665.

5. Sakellaris G, Blevrakis E, Petrakis I, Dimopoulou A, Dede O, Partalis N, et al. Acute coagulopathy in children with multiple trauma: A retrospective study. J Emerg Med. 2014; 47(5): 539-45. doi: 10.1016/j.jemermed.2014.06.018

6. Kunio NR, Differding JA, Watson KM, Stucke RS, Schreiber MA. Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury. UK J Surg 2012; 203(5): 584-8.

7. Jacob CM, & Kumar P. The challenge in management of hemorrhagic shock in trauma. Med J AFI. 2014; 70: 163-9.

8. American College of Surgeons Committee on Trauma. Advanced trauma life support (ATLS) student course manual 9th edition. USA: The Bern Convention and the Uniform Copyright Convention; 2012.

9. Maegele M, Paffrath T, Bouillon B. Acute traumatic coagulopathy in severe injury. Dtsch Arztebl Int. 2011; 108(49): 827-35.

10. Gaunt C & Woolley T. Management of haemorrhage in major trauma. Cont Educat in Anaes, Crit Care & Pain. 2014; 14(6): 251-5.

11. Leenen M, Scholz A, LeferingR, Flohe S. Limited volume resuscitation in hypotensive elderly multiple trauma is safe and prevents early clinic dilutive coagulopathy-a matched pair analysis from Trauma Register of the German Trauma Society. Inj Int J. 2014; 45S: S59-63.

12. Hussmann B, Lefering R, Waydhas C, et al. Dose increased prehospital replacement volume lead to a poor clinical course and increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery
who were managed by an emergency doctor at the accident site. Injury. 2013; 44: 611-7. doi: 10.1016/j.injury. 2012.02.004

13. Shaz BH, Winkler AM, James AB, et al. Pathophysiology of early trauma induced coagulopathy: Emerging evidence for hemodilusion and coagulation factor depletion. J Trauma. 2011; 70 (6): 1401-7.

14. Ministry of Public Health. Public health statistics A.D. Nonthaburi: Ministry of Public Health; 2016.

15. MacLeod JBA, Winkler AM, et al. Early trauma induced coagulopathy (ETIC): Prevalence across the injury spectrum. Injury, 2014; 45(5): 910-5. doi: 10.1016/j.injury.2013.11.004.

16. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Truama. 2003; 54(6): 1127-30. doi: 10.1097/01.TA.0000069184.82147.06

17. Mitra B, Camerona PA, Moria A, et al. Early prediction of acute traumatic coagulopathy. Resuscitation. 2011; 82(9): 1208-13.

18. Johansson P I, Sorensen A M, Perner A, et al. Disseminated intravascular coagulopathy of trauma shock early after trauma? An observational study. Critical Care. 2011; 15: 1-10.