Citation

Lu RP, Ni A, Lin FC, Ortiz-Pujols SM, Adams SD, Monroe DM, Whinna HC, Cairns BA, Key NS. J. Trauma Acute Care Surg. 2013; 74(6): 1474-1479.

Affiliation

From the Department of Pathology and Laboratory Medicine (R.P.L., H.C.W., N.S.K.), Division of Hematology/Oncology (R.P.L., D.M.M., N.S.K.), Department of Medicine, Department of Biostatistics (A.N., F.-C.L.), Department of Surgery (S.M.O.-P., B.A.C.), North Carolina Jaycee Burn Center, and Division of Trauma and Critical Care Surgery (S.D.A.), Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0b013e3182923193

PMID

23694874

Abstract

BACKGROUND: The pathophysiology and time course of coagulopathy after major burns are inadequately understood. Our study objectives were to determine whether acute traumatic coagulopathy (ATC) is seen in burn patients at admission and to determine the changes in international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count (PLT), and hemoglobin (Hgb) in the first 7 days after injury. METHODS: We conducted a retrospective study of patients with burn injury of at least 15% total body surface area who presented to the University of North Carolina. Data on patient demographics, injury characteristics, and laboratory data (INR, aPTT, PLT, and Hgb) at admission and within the first 7 days after injury were recorded. We defined ATC as INR of 1.3 or greater, aPTT of 1.5 or greater times the mean normal limit, and normal PLT at admission. RESULTS: We studied the hematologic profile of 102 patients with burn injury of 15% to 100% total body surface area but did not identify a single patient with ATC at admission. The screening hematologic profile at admission was not influenced by burn severity. In the first 7 days after injury, the INR and aPTT were relatively preserved, while the PLT quickly recovered to baseline after an early decline and the Hgb remained stable at around 10 g/dL; all these changes occurred during the time when the burn patients had received large amounts of fluid resuscitation. CONCLUSION: The screening hematologic profile of burn patients at admission is normal, and the standard screening assays do not suggest the existence of ATC at admission. While this is a relatively small study, it provides evidence to suggest that ATC is unique to trauma patients. LEVEL OF EVIDENCE: Prognostic study, level III.

Language: en