• John R Hess, Allison L Lindell, Lynn G Stansbury, Richard P Dutton, and Thomas M Scalea.
• Departments of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA. jhess@umm.edu
• Transfusion. 2009 Jan 1; 49 (1): 34-9.

BackgroundSeveral groups have reported that a fraction of severely injured patients have abnormal coagulation tests at presentation to trauma centers, even in the absence of significant crystalloid resuscitation. These patients have high mortality, but their prevalence in trauma populations is not clear from the reports.Study Design And MethodsRecords of all patients admitted to a large urban trauma center during 2000 through 2006 were searched for early measures of common coagulation tests and in-hospital mortality.ResultsAbnormal coagulation tests were increasingly frequent with increasing injury severity, ranging from 5 to 43 percent for the prothrombin time as the injury severity scores (ISSs) increased from 5 to more than 45 and 4 to 18 percent for platelet counts of less than 150 x 10(9) per L. Abnormal coagulation tests were associated with excess mortality even below conventional transfusion triggers and this was especially true for the partial thromboplastin time.ConclusionsAbnormal coagulation tests are common in severely injured patients. Even in the moderately injured, they are associated with higher mortality.

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