Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy Clinical Score (TICCS).

TONGLET, Martin; Minon, Jean-Marc; SEIDEL, Laurence; Poplavsky, Jean Louis; Vergnion, Michel

doi:10.1186/s13054-014-0648-0

Article (Scientific journals)

Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy Clinical Score (TICCS).

TONGLET, Martin; Minon, Jean-Marc; SEIDEL, Laurence et al.

2014 • In Critical Care

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/202166

DOI
10.1186/s13054-014-0648-0

PubMed
25425230

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Keywords :

trauma; coagulopathy; transfusion

Abstract :

[en] Introduction: Identifying patients who need damage control resuscitation (DCR) early after trauma is pivotal for adequate management of their critical condition. Several trauma-scoring systems have been developed to identify such patients, but most of them are not simple enough to be used in prehospital settings in the early post-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictly clinical trauma score developed to meet this medical need. Methods: TICCS is a 3-item clinical score (range: 0 to 18) based on the assessment of general severity, blood pressure and extent of body injury and calculated by paramedics on-site for patients with severe trauma. This non-interventional prospective study was designed to assess the ability of TICCS to discern patients who need DCR. These patients were patients with early acute coagulopathy of trauma (EACT), haemorrhagic shock, massive transfusion and surgical or endovascular haemostasis during hospitalization. Diagnosis of EACT was assessed by both thromboelastometry and conventional coagulation tests. Results: During an 18-month period, 89 severe trauma patients admitted to the general emergency unit at our hospital were enrolled in the study, but 7 were excluded for protocol violations. Of the 82 remaining patients, 8 needed DCR and 74 did not. With receiver operating characteristic curve analysis, TICCS proved to be a powerful discriminant test (area under the curve = 0.98; 95% CI: 0.92 to 1.0). A cutoff of 10 on the TICCS scale provided the best balance between sensitivity (100%; 95% CI: 53.9 to 100) and specificity (95.9%; 95% CI: 88.2 to 99.2). The positive predictive value was 72.7%, and the negative predictive value was 100.0%. Conclusion: TICCS can be easily and rapidly measured by paramedics at the trauma site. In this study of blunt trauma patients, TICCS was able to discriminate between patients with and without need for DCR. TICCS on-site evaluation should allow initiation of optimal care immediately upon hospital admission of patients with severe trauma in need of DCR. However, a larger multicentre prospective study is needed for in-depth validation of TICCS.

Disciplines :

Human health sciences: Multidisciplinary, general & others

Author, co-author :

TONGLET, Martin ; Centre Hospitalier Universitaire de Liège - CHU > Urgences

Minon, Jean-Marc

SEIDEL, Laurence ; Centre Hospitalier Universitaire de Liège - CHU > Service d'Informations médico économiques (SIME)

Poplavsky, Jean Louis

Vergnion, Michel

Language :

English

Title :

Publication date :

26 November 2014

Journal title :

Critical Care

ISSN :

1364-8535

eISSN :

1466-609X

Publisher :

BioMed Central, London, United Kingdom

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 30 September 2016

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Bibliography

Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT. Epidemiology of traumatic deaths: a reassessment. J Trauma 1995, 38:185-193. 10.1097/00005373-199502000-00006, 7869433.
Acosta J, Yang JC, Winchell RJ, Simons RK, Fortlage D, Hollingsworth-Fridlund P, Hoyt DB. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg 1998, 186:528-533. 10.1016/S1072-7515(98)00082-9, 9583692.
Kauvar DS, Lefering R, Wade CE. Impact of hemorrhage on trauma outcome: an overview of epidemiology, clinical presentations and therapeutic considerations. J Trauma 2006, 60(6 Suppl):S3-S11. 10.1097/01.ta.0000199961.02677.19, 16763478.
Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003, 54:1127-1130. 10.1097/01.TA.0000069184.82147.06, 12813333.
Macleod J, Lynn M, McKenney M, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma 2003, 55:39-44. 10.1097/01.TA.0000075338.21177.EF, 12855879.
Maegele M, Lefering R, Yucel N, Tjardes T, Rixen D, Paffrath T, Simanski C, Neugebauer E, Bouillon B. Early coagulopathy in multiple injury: an analysis from the German Trauma Registry on 8724 patients. Injury 2007, 38:298-304. 10.1016/j.injury.2006.10.003, 17214989.
Beekey AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med 2008, 36(7 Suppl):S267-S274. 10.1097/CCM.0b013e31817da7dc.
Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013, 17:R76. 10.1186/cc12685, 23601765.
Johansson PI, Oliveri R, Ostrowski SR. Hemostatic resuscitation with plasma and platelets in trauma: a meta-analysis. J Emerg Trauma Shock 2012, 5:120-125. 10.4103/0974-2700.96479, 22787340.
Duchesne JC, Hunt JP, Wahl G, Marr AB, Wang YZ, Weintraub SE, Wright MJ, McSwain NE. Review of current blood transfusions strategies in a mature level I trauma center: Were we wrong for the last 60 years?. J Trauma 2008, 65:272-278. 10.1097/TA.0b013e31817e5166, 18695461.
Holcomb JB, Wade CE, Michalek JE, Chisholm GB, Zarzabal LA, Schreiber MA, Gonzalez EA, Pomper GJ, Perkins JG, Spinella PC, Williams KL, Park MS. Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg 2008, 248:447-458. 18791365.
Duchesne JC, Kimonis K, Marr AB, Rennie KV, Wahl G, Wells JE, Islam TM, Meade P, Stuke L, Barbeau JM, Hunt JP, Baker CC, McSwain NE. Damage control resuscitation in combination with damage control laparotomy: a survival advantage. J Trauma 2010, 69:46-52. 10.1097/TA.0b013e3181df91fa, 20622577.
Shakur H, Roberts I, Bautista R, Caballero J, Coats T, Dewan Y, El-Sayed H, Gogishaishvili T, Gupta S, Herrera J, Hunt B, Iribhogbe P, Izurieta M, Khamis H, Komolafe E, Marrero MA, Mejía-Mantilla J, Miranda J, Morales C, Olaomi O, Olldashi F, Perel P, Peto R, Ramana PV, Ravi RR, Yutthakasemsunt S. Effects of tranexamic acid on death, vascular occlusive events and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomized, placebo-controlled trial. Lancet 2010, 376:23-32. 10.1016/S0140-6736(10)61479-1, 20554319.
Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point-of-care coagulation devices. Anesth Analg 2008, 106:1366-1375. 10.1213/ane.0b013e318168b367, 18420846.
Holcomb JB, Minei KM, Scerbo ML, Radwan ZA, Wade CE, Kozar RA, Gill BS, Albarado R, McNutt MK, Khan S, Adams PR, McCarthy JJ, Cotton BA. Admission rapid thromboelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg 2012, 256:476-486. 10.1097/SLA.0b013e3182658180, 22868371.
Baker JB, Korn CS, Robinson K, Chan L, Henderson SO. Type and crossmatch of trauma patient. J Trauma 2001, 50:878-881. 10.1097/00005373-200105000-00017, 11371845.
McLaughlin DF, Niles SE, Salinas J, Perkins JG, Cox ED, Wade CE, Holcomb JB. A predictive model for massive transfusion in combat casualty patient. J Trauma 2008, 64(2 Suppl):S57-S63. 10.1097/TA.0b013e318160a566, 18376173.
Mitra B, Cameron P, Mori A, Maini A, Fitzgerald M, Paul E, Street A. Early prediction of acute traumatic coagulopathy. Resuscitation 2011, 82:1208-1213. 10.1016/j.resuscitation.2011.04.007, 21600687.
Nunez TC, Voskresensky IV, Dossett L, Shinall R, Dutton WD, Cotton BA. Early prediction of massive transfusion in trauma: simple as ABC (assessment of blood consumption)?. J Trauma 2009, 66:346-352. 10.1097/TA.0b013e3181961c35, 19204506.
Yücel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, Neugebauer EAM, Wappler F, Bouillon B, Rixen D. Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma. J Trauma 2006, 60:1228-1237. 10.1097/01.ta.0000220386.84012.bf, 16766965.
Vandromme MJ, Griffin RL, McGwin G, Weinberg JA, Rue LW, Kerby JD. Prospective identification of patients at risk for massive transfusion: an imprecise endeavor. Am Surg 2011, 77:155-161. 21337871.
Schreiber M, Perkins J, Kiraly L, Underwood S, Wade CE, Holcomb JB. Early predictors of massive transfusion in combat casualties. J Am Coll Surg 2007, 205:541-545. 10.1016/j.jamcollsurg.2007.05.007, 17903727.
Rainer TH, Ho AMH, Yeung JHH, Cheung NK, Wong RSM, Tang N, Ng SK, Wong GKC, Lai PBS, Graham CA. Early risk stratification of patients with major trauma requiring massive blood transfusion. Resuscitation 2011, 82:724-729. 10.1016/j.resuscitation.2011.02.016, 21458905.
Brockamp T, Nienaber U, Mutschler M, Wafaisade A, Peiniger S, Lefering R, Bouillon B, Maegele M, TraumaRegister DGU. Predicting on-going hemorrhage and transfusion requirement after severe trauma: a validation of six scoring systems and algorithms on the TraumaRegister DGU. Crit Care 2012, 16:R129. 10.1186/cc11432, 22818020.
Cotton BA, Gunter OL, Isbell J, Au BK, Robertson AM, Morris JA, St Jacques P, Young PP. Damage control hematology: the impact of a trauma exsanguinating protocol on survival and blood product utilization. J Trauma 2008, 64:1177-1183. 10.1097/TA.0b013e31816c5c80, 18469638.
Inaba K, Branco BC, Rhee P, Blackbourne LH, Holcomb JB, Teixeira PG, Shulman I, Nelson J, Demetriades D. Impact of plasma transfusion in trauma patients who do not require massive transfusion. J Am Coll Surg 2010, 210:957-965. 10.1016/j.jamcollsurg.2010.01.031, 20510805.
Tonglet M, Minon JM, Damas F, Clanet M, Vergnion M. [Implementation of a massive transfusion protocol in an emergency department] [Article in French]. Rev Med Liege 2014, 69:82-88. 24683828.