Grading clinical coagulopathy and predicting massive transfusion

Abstract

Uncontrolled haemorrhage and complicating trauma-induced coagulopathy (TIC) remain the most common causes of preventable death after trauma. Early identification of patients at risk together with aggressive management has been linked to improved outcomes including survival. The identification of trauma-induced coagulopathy and patients requiring massive transfusion can be done using conventional coagulation tests, viscoelastic point-of-care tests or clinician's gestalt. Early prediction models and scoring systems may be a useful and efficient method of promptly identifying of vulnerable patients so that effective treatment can be expedited. Several such prediction models have been developed: some aim to predict the presence of biochemical coagulopathy, as diagnosed on conventional coagulation tests, while some seek to quickly evaluate a patient's risk of requiring massive transfusion. The scores have several components in common: systolic hypotension, severity of injury and evidence of ongoing haemorrhage. Of the four coagulopathy prediction models and the fifteen massive transfusion prediction models thus far developed and published, none have yet been prospectively validated on a large external population and none are in widespread clinical use. The implementation of an accurate prediction technique may reduce delays in the activation of massive transfusion protocols, increase the provision of effective ratios of blood products in massive transfusion, reduce reliance on clinical acumen in the fast-paced trauma environment and decrease mortality among the severely injured.