Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy Clinical Score (TICCS).

摘要

Introduction: Identifying patients who need damage control resuscitation (DCR) early after trauma is pivotal foradequate management of their critical condition. Several trauma-scoring systems have been developed toidentify such patients, but most of them are not simple enough to be used in prehospital settings in the earlypost-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictlyclinical trauma score developed to meet this medical need.Methods: TICCS is a 3-item clinical score (range: 0 to 18) based on the assessment of general severity, bloodpressure and extent of body injury and calculated by paramedics on-site for patients with severe trauma. Thisnon-interventional prospective study was designed to assess the ability of TICCS to discern patients who needDCR. These patients were patients with early acute coagulopathy of trauma (EACT), haemorrhagic shock, massivetransfusion and surgical or endovascular haemostasis during hospitalization. Diagnosis of EACT was assessed byboth thromboelastometry and conventional coagulation tests.Results: During an 18-month period, 89 severe trauma patients admitted to the general emergency unit at ourhospital were enrolled in the study, but 7 were excluded for protocol violations. Of the 82 remaining patients, 8needed DCR and 74 did not. With receiver operating characteristic curve analysis, TICCS proved to be a powerfuldiscriminant test (area under the curve = 0.98; 95% CI: 0.92 to 1.0). A cutoff of 10 on the TICCS scale provided thebest balance between sensitivity (100%; 95% CI: 53.9 to 100) and specificity (95.9%; 95% CI: 88.2 to 99.2). The positivepredictive value was 72.7%, and the negative predictive value was 100.0%.Conclusion: TICCS can be easily and rapidly measured by paramedics at the trauma site. In this study of blunttrauma patients, TICCS was able to discriminate between patients with and without need for DCR. TICCS on-siteevaluation should allow initiation of optimal care immediately upon hospital admission of patients with severetrauma in need of DCR. However, a larger multicentre prospective study is needed for in-depth validation of TICCS.