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Diagnostic performance of prothrombin time point-of-care to detect acute traumatic coagulopathy on admission: experience of 522 cases in trauma center.

Abstract：

BACKGROUND:Early identification of acute traumatic coagulopathy is a key challenge during initial management to determine whether to initiate early hemostatic support. We assessed the performance of prothrombin time (PT) at point-of-care in trauma patients to detect moderate and severe coagulopathy on admission. STUDY DESIGN AND METHODS:All admitted consecutive trauma patients were analyzed retrospectively between April 2014 and July 2015. PT was measured on admission with both a PT point-of-care device (PTr-CGK) and a standard coagulation test (PTr-STD). The results for PTr-CGK and PTr-STD were compared using analysis of agreement, precision, and accuracy. The diagnostic performance of PTr-CGK to predict coagulopathy was established by analysis of receiver operating characteristic curves. The predictive performance of different thresholds and risk factors for misclassification were also studied. RESULTS:Over a 16-month period, 522 patients were included. PTr-CGK estimated PTr-STD with a bias of 0.00 (95% confidence interval [CI], -0.48 to 0.50) and a precision of 0.25. The optimal threshold was 1.4 to predict severe coagulopathy (sensitivity 81% [95% CI, 68%-94%], negative predictive value 98% [95% CI, 97%-99%]), and 1.2 for moderate coagulopathy (sensitivity 80% [95% CI, 72%-88%], negative predictive value 94% [95% CI, 91%-96%]). A low PTr-CGK in the presence of severity criteria (Injury Severity Score ≥ 16, Trauma Associated Severe Hemorrhage score ≥ 12, hemoglobin level < 7 g/dL, fibrinogen level < 2 g/L, base deficit ≥ 6 mmol/L) was strongly associated with a false-negative risk. CONCLUSIONS:The PT point-of-care device is reliable and accurate for the early identification of coagulopathic trauma patients.

journal_name

Transfusion

journal_title

Transfusion

authors

Deras P,Nouri J,Martinez O,Aubry E,Capdevila X,Charbit J

doi

10.1111/trf.14643

subject

Has Abstract

pub_date

2018-07-01 00:00:00

pages

1781-1791

issue

7

eissn

0041-1132

issn

1537-2995

journal_volume

58

pub_type

杂志文章

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