Early Recognition of Acute Coagulopathy May Reduce MortalitiesGeneral

Dr Aslam Noorbhai.Dr Aslam Noorbhai.

Early recognition of acute coagulopathy may help reduce morbidity and mortality, a UKZN study has revealed.

The research was conducted by the Specialist General Surgeon at the Department of General Surgery and Lecturer, Dr Aslam Noorbhai.

Titled, “Elevated International Normalised Ratios Correlate with Severity of Injury and Outcome Objectives”, the study aimed to assess the prevalence of ACoTS at the level 1 trauma unit at Inkosi Albert Luthuli Central Hospital in Durban and correlate it with injury severity and in-hospital mortality.

ACoTS is often present in trauma patients, particularly those severely injured.

According to Noorbhai, haemorrhagic shock is the leading cause of preventable early deaths from trauma.

‘Acute coagulopathy on admission to a trauma unit is associated with worse outcomes. The relationship of haemorrhage to early mortality remains consistent regardless of the mechanism of injury. Haemorrhage and haemorrhagic shock are increasingly amenable to interventions that result in reductions in morbidity and mortality,’ said Noorbhai. 

Noorbhai conducted a retrospective analysis of the first 1 000 patients admitted to the trauma unit at IALCH between 2007 and 2011. Of the 1 000 patients, 752 were male. There were 261 admissions directly from the scene and 739 inter-hospital transfers (non-scene).

He correlated the admission international normalised ratios (INRs) with Injury Severity Scores (ISSs) and in-hospital mortality.

He used a multivariable Poisson model with robust standard errors to assess the relationship between coagulopathy and mortality after adjustment for the confounding influence of age and gender. He used the R statistics programme to analyse data.

The study found a high prevalence of coagulopathy. ‘Raised admission INRs were associated with worse outcomes,’ Noorbhai said.

‘There is a direct correlation between the INR and the ISS. INRs may offer predictive capabilities in resource-depleted environments where the ISS is not routinely calculated.’

The study found that the overall prevalence of coagulopathy was comparable to previous studies and was high in both direct admissions and inter-hospital transfers. ‘Raised admission INRs were associated with worse outcomes. There was a direct correlation between INRs and ISSs. The INR may help identify patients at risk in resource-depleted environments,’ said Noorbhai.

He believes further studies will assist in identifying optimal overall cut-off values for INR, ISS and ISS subgroups that would help identify patients at risk. ‘Earlier recognition of ACoTS may help reduce mortality,’ he added.

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