Combining Early Coagulation and Inflammatory Status Improves Prediction of Mortality in Burned and Nonburned Trauma Patients

Abstract

Background: After injury, there is a synergistic response between inflammation and coagulation systems. We hypothesized that combining markers of these processes and standard clinical indices would improve early prediction of inhospital mortality in burned and nonburned trauma patients. Methods: Patients admitted to the surgical or burn intensive care unit within 24 hours of injury with an anticipated stay >3 days were enrolled during a one year period. Upon admission, blood was drawn for thromboelastography, plasma-based clotting assays, and cytokine levels. Clinical indices and multiple organ dysfunction syndrome (MODS) scores were recorded. Candidate variables evaluated included age, percentage third degree burns, inhalation injury, percentage total body surface area burns, interleukin-6, tumor necrosis factor alpha, interleukin-8, prothrombin time, partial thromboplastin time (PTT), maximal amplitude reflective of clot strength, group (burn or nonburn) and admission MODS. Results: For model development, we enrolled 25 burned and 33 nonburned trauma patients (20 blunt and 13 penetrating injuries). Fifteen deaths occurred. Multiple logistic regression analysis identified six independent risk factors for death: age, percentage third degree burns, inhalation injury, tumor necrosis factor alpha level, maximal amplitude, and MODS score with an area under ROC curve of 0.961. Conclusion: Our model improves prediction of in-hospital mortality in comparison to previous methods for burn and nonburn trauma patients. Furthermore, our model is equally applicable to all patients regardless of type of traumatic injury (nonburn or burn). This improvement is because of the inclusion of patient's early coagulation and inflammatory status in addition to standard clinical indices. These data provide a baseline within which to measure incremental improvements in care.

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Document Details

Document Type
Technical Report
Publication Date
Feb 01, 2008
Accession Number
ADA480367

Entities

People

  • Anthony E. Pusateri
  • Charles E Wade
  • Gerald A. Merrill
  • Jingjing Wang
  • John B Holcomb
  • Josè Salinas
  • Kevin Chung
  • Myung S. Park
  • Steven Wolf
  • Wenjun Martini

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Acute Respiratory Distress Syndrome
  • Biological Factors
  • Blood
  • Blood Coagulation
  • Blood Coagulation Factors
  • Burns
  • Data Science
  • Databases
  • Health Services
  • Hemorrhagic Shock
  • Hospitals
  • Information Science
  • Measurement
  • Proteins
  • Regression Analysis
  • Shock (Pathology)
  • Surgery

Fields of Study

  • Medicine

Readers

  • Trauma Surgery or Emergency Medicine.
  • Trauma or Military Medicine

Technology Areas

  • AI & ML
  • AI & ML - Bayesian Inference