• Karim Brohi, Jasmin Singh, Mischa Heron, and Timothy Coats.
• Trauma and Critical Care Unit, Royal London Hospital, United Kingdom. karim@trauma.org
• J Trauma. 2003 Jun 1;54(6):1127-30.

BackgroundTraumatic coagulopathy is thought to be caused primarily by fluid administration and hypothermia.MethodsA retrospective study was performed to determine whether coagulopathy resulting from the injury itself is a clinically important entity in severely injured patients.ResultsOne thousand eight hundred sixty-seven consecutive trauma patients were reviewed, of whom 1,088 had full data sets. Median Injury Severity Score was 20, and 57.7% had an Injury Severity Score > 15; 24.4% of patients had a significant coagulopathy. Patients with an acute coagulopathy had significantly higher mortality (46.0% vs. 10.9%; chi2, p < 0.001). The incidence of coagulopathy increased with severity of injury, but was not related to the volume of intravenous fluid administered (r2 = 0.25, p < 0.001).ConclusionThere is a common and clinically important acute traumatic coagulopathy that is not related to fluid administration. This is a marker of injury severity and is related to mortality. A coagulation screen is an important early test in severely injured patients.

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