Prehospital identification of trauma patients with early acute coagulopathy and massive bleeding: results of a prospective non-interventional clinical trial evaluating the Trauma Induced Coagulopathy…

Martin L Tonglet, Jean Marc Minon, Laurence Seidel, Jean Louis Poplavsky, Michel Vergnion

IntroductionIdentifying patients in need for Damage Control Resuscitation (DCR) early after trauma, is pivotal for adequate management of their critical condition. Several trauma-scoring systems have been developed to identify such patients but most of them are not simple enough to be used in the pre-hospital settings at the early post-traumatic phase. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure and strictly clinical trauma score developed to meet this medical need.MethodsTICCS is a 3-item clinical score (range 0 to 18) based on the assessment of general severity, blood pressure and extent of body injury and calculated by paramedics on site for patients with severe trauma. This non-interventional prospective study was designed to assess the ability of TICCS to discern patients in need for DCR. These patients were patients with Early Acute Coagulopathy of Trauma (EACT), haemorrhagic shock, massive transfusion (MT) and surgical or endovascular haemostasis during hospitalization. Diagnosis of EACT was assessed by both thromboelastometry and conventional coagulation tests.ResultsDuring 18 months, 89 severe trauma patients admitted to the general emergency unit were enrolled in the study but seven were excluded for protocol violation. Of the 82 patients, eight needed DCR and 74 did not. Using receiver operating characteristic curve analysis, TICCS proved to be a powerful discriminant test (area under the curve =0.98; 95% CI: 0.92 to 1.0). A cut-off of 10 on the TICCS scale provided the best balance between sensitivity (100%; 95%CI: 53.9 to 100) and specificity (95.9%; 95%CI: 88.2 to 99.2). The positive predictive value was 72.7% and the negative predictive value 100.0%.ConclusionTICCS can be easily and rapidly measured on the site of trauma by paramedics. In this study of blunt trauma patients, TICCS was able to discriminate between patients with and without need for DCR. TICCS on-site evaluation should allow initiation of optimal care immediately upon hospital admission of patients with severe trauma in need of DCR. In-depth validation of TICCS though requires a larger multicenter prospective study.Trial registrationclinicaltrials.gov NCT02132208 Registered 6 May 2014.