• Daniel Bodnar, Emma Bosley, Steven Raven, Sue Williams, Glenn Ryan, Martin Wullschleger, and Alfred K Lam.
• Office of the Medical Director, Queensland Ambulance Service, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Herston, Australia; Emergency Department, Queensland Children's Hospital, South Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia. Electronic address: daniel.bodnar@health.qld.gov.au.
• Injury. 2024 Jan 1; 55 (1): 111124111124.

BackgroundAcute Traumatic Coagulopathy (ATC) is a complex pathological process that is associated with patient mortality and increased blood transfusion requirements. It is evident on hospital arrival, but there is a paucity of information about the nature of ATC and the characteristics of patients that develop ATC in the pre-hospital setting. The objective of this study was to describe the nature and timing of coagulation dysfunction in a cohort of injured patients and to report on patient and pre-hospital factors associated with the development of ATC in the field.MethodsThis was a prospective observational study of a convenience sample of trauma patients. Patients had blood taken during the pre-hospital phase of care and evaluated for derangements in Conventional Coagulation Assays (CCA) and Rotational Thromboelastometry (ROTEM). Associations between coagulation derangement and pre-hospital factors and patient outcomes were evaluated.ResultsA total of 216 patients who had either a complete CCA or ROTEM were included in the analysis. One hundred and eighty (83 %) of patients were male, with a median injury severity score of 17 [interquartile range (IQR) 10-27] and median age of 34 years [IQR = 25.0-52.0]. Hypofibrinogenemia was the predominant abnormality seen, (CCA Hypofibrinogenemia: 51/193, 26 %; ROTEM hypofibrinogenemia: 65/204, 32 %). Increased CCA derangement, the presence of ROTEM coagulopathy, worsening INR, worsening FibTEM and decreasing fibrinogen concentration, were all associated with both mortality and early massive transfusion.ConclusionClinically significant, multifaceted coagulopathy develops early in the clinical course, with hypofibrinogenemia being the predominant coagulopathy. In keeping with the ED literature, pre-hospital coagulation dysfunction was associated with mortality and early massive transfusion. Further work is required to identify strategies to identify and guide the pre-hospital management of the coagulation dysfunction seen in trauma.Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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