Trauma bay haemoglobin level. Predictor of coagulation disorder in major trauma

BACKGROUND: Trauma-induced coagulopathy is common in patients with major trauma and requires early and appropriate treatment for bleeding control. Even in emergency laboratory, the availability of standard coagulation tests is associated with certain latencies and devices for viscoelastic haemostasis diagnosis (thromboelastometry) are not routinely established in major trauma centres. PURPOSE: We searched for a laboratory parameter with fast availability by point of care blood gas analysis and reliable correlation with coagulation parameters. METHODS: We analyzed the trauma patients of a single level one trauma centre from 2005-2011 and particularly evaluated the correlation between haemoglobin (Hb) and coagulation parameters and the correlation of Hb and parameters indicating tissue perfusion. All patients who were directly admitted from the scene of an accident to the trauma centre had an injury severity score (ISS) > 9, had a complete revised injury severity classification (RISC) and blood samples that were taken in the emergency department (ED) immediately after admission were included. Correlations were tested using the Pearson test (r) with a two-tailed significance level of p < 0.05. RESULTS: A total of 425 patients met inclusion criteria presenting with a mean age of 43 years, 76% male gender and mean ISS of 30.4. Significant correlation (p < 0.01) between Hb and prothrombin time (Quick) (r = 0.652), Hb and partial thromboplastin time (PTT) (r = - 0.434), Hb and platelet count (r = 0.501) and Hb and base excess (BE) (0.408) was found. No significant correlation between Hb and lactate was found. CONCLUSION: We found a robust correlation of Hb and Quick in a single centre trauma population. These data suggest that especially severely injured trauma patients with persistent bleeding might benefit from an Hb-based algorithm for early correction of coagulation disorders. Further studies with larger trauma populations are required to confirm our findings.