Critically injured patients need rapid and appropriate
hemostatic treatment, which requires prompt identification of trauma-induced
coagulopathy (TIC) upon hospital admission. We developed and validated the
performance of a clinical score based on prehospital resuscitation parameters
and vital signs at hospital admission for early diagnosis of TIC.
Methods
The score was derived from a level-1 trauma center registry
(training set). It was then validated on data from two other level-1 trauma
centers: first on a trauma registry (retrospective validation set), and then on
a prospective cohort (prospective validation set). TIC was defined as a PTratio > 1.2
at hospital admission. Prehospital (vital signs and resuscitation care) and
admission data (vital signs and laboratory parameters) were collected. We
considered parameters independently associated with TIC in the score (binomial
logistic regression). We estimated the score’s performance for the prediction
of TIC.
Results
A total of 3489 patients were included, and among these a
TIC was observed in 22% (95% CI 21–24%) of cases. Five criteria were identified
and included in the TIC Score: Glasgow coma scale < 9, Shock Index > 0.9,
hemoglobin < 11 g.dL−1, prehospital fluid volume > 1000 ml, and
prehospital use of norepinephrine (yes/no). The score, ranging from 0 and 9
points, had good performance for the identification of TIC (AUC: 0.82, 95% CI:
0.81–0.84) without differences between the three sets used. A score
value < 2 had a negative predictive value of 93% and was selected to
rule-out TIC. Conversely, a score value ≥ 6 had a positive predictive value of
92% and was selected to indicate TIC.
Conclusion
The TIC Score is quick and easy to calculate and can
accurately identify patients with TIC upon hospital admission.
