Fibrinogen on Admission in Trauma score: Early prediction of low plasma fibrinogen concentrations in trauma patients

摘要

BACKGROUNDEarly recognition of low fibrinogen concentrations in trauma patients is crucial for timely haemostatic treatment and laboratory testing is too slow to inform decision-making.OBJECTIVETo develop a simple clinical tool to predict low fibrinogen concentrations in trauma patients on arrival.DESIGNRetrospective cohort study.SETTINGThree designated level 1 trauma centres in the Paris Region, from January 2011 to December 2013.PATIENTSPatients admitted in accordance with national triage guidelines for major trauma and plasma fibrinogen concentration testing on admission.INTERVENTIONConstruction of a clinical score [Fibrinogen on Admission in Trauma (FibAT) score] in a derivation cohort to predict fibrinogen plasma concentration 1.5g l(-1) or less after multiple regressions. One point was given for each predictive factor. The score was the sum of all. Validation was performed in a separate validation cohort.MAIN OUTCOME MEASUREPredictive accuracy of FibAT score.RESULTSIn total, 2936 patients were included, 2124 in the derivation cohort and 812 in the validation cohort. In the derivation cohort, a multivariate logistic model identified the following predictive factors for plasma fibrinogen concentrations 1.5g l(-1) or less: age less than 33 years, prehospital heart rate more than 100 beats per minute, prehospital SBP less than 100mmHg, blood lactate concentration on admission more than 2.5 mmol l(-1), free intraabdominal fluid on sonography, decrease in haemoglobin concentration from prehospital to admission of more than 2g dl(-1), capillary haemoglobin concentration on admission less than 12g dl(-1) and temperature on admission less than 36 degrees C. The FibAT score had an area under the receiver operating characteristic curve of 0.87 [95% confidence interval (0.86 to 0.91)] in the derivation cohort and of 0.82 (95% confidence interval (0.86 to 0.91)] in the validation cohort to predict a low plasma fibrinogen.CONCLUSIONThe FibAT score accurately predicts plasma fibrinogen levels 1.5g l(-1) or less on admission in trauma patients. This easy-to-use score could allow early, goal-directed therapy to trauma patients.