Journal of Emergencies, Trauma, and Shock
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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 1  |  Page : 38-41

Early Predictive Factors of Hypofibrinogenemia in Acute Trauma Patients


1 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital; Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
2 Department of Internal Medicine; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
3 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital; Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
4 Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
5 Gerash Medical School, Shiraz University of Medical Sciences, Gerash, Iran

Correspondence Address:
Dr. Shahram Bolandparvaz
Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Chamran Avenue, P.O. Box: 71345-1876, Shiraz
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JETS.JETS_37_17

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Background: Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy. Aims: The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients. Settings and Design: This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition. Materials and Methods: Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml. Results: A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury. Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = −4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml. When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved). Conclusions: Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.


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