Profile of abnormal results of conventional coagulation tests in Trauma Patients.

Aravinth, S (2012) Profile of abnormal results of conventional coagulation tests in Trauma Patients. Masters thesis, PSG Institute of Medical Sciences & Research, Coimbatore.

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Abstract

Trauma is a serious global health problem accounting for approximately 1 in 10 deaths worldwide1. Approximately 50% of trauma related deaths occur immediately and these deaths can only be avoided by injury prevention. 30% of the trauma patients die during the initial hours post injury and preventing these deaths is the goal of modern trauma care. The commonest cause for this death is uncontrolled non-surgical hemorrhage. This is potentially preventable. Hence identification of the cause of bleeding and effective control of bleeding is expected to decrease mortality. All of this has to be achieved in the ‘Golden Hour’ i.e. within 1 hour of a severe injury. Life threatening bleeding in trauma patients due to vascular injury often requires surgical intervention. Sometimes arterial embolization may be required in patients with multiple trauma. A review of recent literature shows an acute ‘Coagulopathy of Trauma’ (COT) as a distinct entity and is said to be present in 1 of 4 severely injured trauma patients in the western world when tested within 1 hour of admission. This caused diffuse bleeding [exsanguination] and is more difficult to manage and requires transfusion by fresh frozen plasma, platelets and coagulation factor concentrates instead of the conventional intravenous fluids, plasma expanders and packed cells alone. The diagnosis of this acute coagulopathy can be made by performing basic tests for coagulation such as Prothrombin time (PT), partial thromboplastin time (APTT) and Ddimer. The objective of the study was to observe the occurrence of ‘Coagulopathy of Trauma’ in severely injured trauma patients, by examining the results of the basic screening tests for coagulation, such as Prothrombin Time [PT], Activated Partial Thromboplastin Time [APTT], D-dimer and Platelet count. The study population was 62 patients with severe injuries [i.e. Revised Trauma Score between 4/12 & 11/12], admitted directly to the Emergency Medicine Department of PSGIMSR Hospital. We found that most of these patients were aged between 21 & 40 years and that most of them were males. 23% of the patients had abnormal results of PT, while 4.8% had abnormal results of APPT. However, 76% had abnormal results of Ddimers, thus highlighting that a fibrinolytic activity existed in most patients with severe injuries. 11.3% had thrombocytopenia on admission. 81% of the study population had abnormal results of any 1 of the screening tests for coagulation. Hence we recommend that it is essential to perform these screening tests in all trauma patients with severe injuries to identify the coagulopathy of trauma, so that, the patients are provided with appropriate evidence-based therapy. All the 5 patients who had isolated head injuries had abnormal results of any 1 of the screening tests for coagulation. Of these, 2 patients had abnormal results of all the 4 parameters and died within 24 hours of admission. This substantiates the current practice in neurosurgery, to perform the screening tests for coagulation for all patients with head injury, however trivial it might be on physical examination. Further studies are essential to correlate abnormal results of screening tests for coagulation in severely injured trauma patients, with outcomes such as duration of hospital stay, morbidity and mortality.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Profile of abnormal results; conventional coagulation tests; Trauma Patients.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 21 Jun 2017 10:24
Last Modified: 22 Jun 2017 05:38
URI: http://repository-tnmgrmu.ac.in/id/eprint/192

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