An Analysis of the Presence of Coagulopathy on Arrival to Emergency Departments in Deployed Military Treatment Facilities.

INTRODUCTION

Acute traumatic coagulopathy remains a high predictor of mortality; however, the incidence and outcomes in the military population have limited data. The goal of our study is to characterize coagulopathy on arrival to deployed Role 2 and Role 3 Military Treatment Facilities (MTFs).

MATERIALS AND

METHODS

We utilized the Department of Defense Trauma Registry to identify United States (U.S.) military, Coalition forces, and U.S. contractors with documentation of international normalized ratio (INR) in the emergency department. We defined coagulopathy as INR of ≥1.6 based on Youden's index, with INR as the independent variable and 24-hour survival as the outcome variable. We constructed multivariable logistic regression models with coagulopathy as the outcome variable to test for associations.

RESULTS

There were 13,015 encounters that met inclusion for our primary analysis. Based on the receiver operating characteristic (ROC) analysis, coagulopathy was defined as ≥1.6 (area under the ROC = 0.862). Using this threshold, 999 patients met criteria for coagulopathy. Explosions were the predominate mechanism among both groups (69% among those with coagulopathy vs. 59%, P < 0.001). Median composite injury severity scores were 24 (11-33) among those with coagulopathy versus 6 (3-13, P < 0.001). The body regions most frequently sustaining serious injuries were the head/neck (29% vs. 9%) and the extremities (47% vs. 22%, P < 0.001). Survival was lower at 24 hours (91% vs. 99%) and discharge (83% vs. 99%, P < 0.001). In our adjusted model, serious injuries to the head/neck (odds ratio [OR] 3.61, 95% confidence interval [CI] 3.05-4.26) and skin (3.88, 2.94-5.11) were most associated with coagulopathy. Prehospital blood administration (OR 1.08, 0.73-1.61) and fluid administration (1.03, 0.77-1.37) were not associated.

CONCLUSIONS

Nearly 1 in 12 casualties within our dataset had evidence of coagulopathy on arrival to deployed MTFs with surgical capabilities. Our will help guide future research efforts.