Prediction of extravasation in pelvic fracture using coagulation biomarkers

Aoki, Makoto; Hagiwara, Shinji; Tokue, Hiroyuki; Shibuya, Kazuhiko; Kaneko, Minoru; Murata, Masato; Nakajima, Jun; Sawada, Yusuke; Isshiki, Yuta; Ichikawa, Yumi; Oshima, Kiyohiro

doi:10.1016/j.injury.2016.05.012

Cited by 9 publications

(9 citation statements)

References 31 publications

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“…Coagulation biomarkers were obviously affected by the presence of another anatomical injury, except for the pelvis. As a result, the predictive nature of coagulation biomarkers for arterial extravasation in pelvic fracture was decreased; however, this was of a medium level of accuracy [10]. In a clinical situation, patients with severe pelvic fracture often have another more severely injured body region.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with a pelvic fracture who received prehospital treatment comprising only crystalloids and/or packed red blood cell infusions and who were tested for coagulation biomarkers on ED arrival were included. We defined exclusion criteria according to that of our previous study [10]: (1) abbreviated injury scale (AIS) scores in another region that was higher than the pelvis AIS score, (2) arterial extravasation in regions other than the pelvis, and (3) unknown time of trauma occurrence. In addition, we excluded pelvic fracture patients with unstable hemodynamics (systolic blood pressure below 90 mmHg on ED arrival and/or lactate level above 5.0 mmol/L).…”

Section: Methodsmentioning

confidence: 99%

“…The following parameters were obtained on ED arrival: patient demographics, use of anticoagulation, and/or antiplatelet drugs, trauma mechanism, vital signs at ED arrival (the Glasgow Coma Scale, systolic blood pressure, heart rate, and respiratory rate), results of blood tests (hemoglobin and lactate levels, levels of fibrin degradation products [FDP], D-dimer and fibrinogen, prothrombin time–international normalized ratio [PT–INR]), AIS for each body region, injury severity score (ISS), patterns of pelvic fracture classified by Young and Burgess classification [12], World Society of Emergency Surgery (WSES) classification [13], angiography for the pelvis, treatment for pelvic fracture (TAE, external fixation, preperitoneal packing, and amount of blood transfusion within 24 h (in Japan, 1 U of packed red blood cells is approximately 140 mL), time course (door to CT time and door to angiography time), and mortalities (24 h and 30 days). With regard to analytic variables, the ratio of FDP to fibrinogen (FDP/fibrinogen) was also calculated, as with our previous study [10]. FDP and D-dimer were measured using an immunoturbidimetric method and using Cs-2000i and Cs-5100 systems (Sysmex Corporation, Kobe, Japan).…”

Section: Methodsmentioning

confidence: 99%

“…In response, we report on the predictive nature of coagulation biomarkers for arterial extravasation in patients with pelvic fracture as a supplementary method of contrast-enhanced CT [10]. However, a practical problem in our previous study was that it included all pelvic fracture patients regardless of their hemodynamic status: In a real clinical situation, most clinicians will not hesitate to undertake hemostatic treatment of pelvic fracture cases with unstable hemodynamics.…”

Section: Introductionmentioning

confidence: 99%

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Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers

et al. 2019

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BackgroundDetermining the presence of an active arterial hemorrhage in the acute phase is important as a treatment strategy in patients with pelvic fracture. The purpose of this study was to evaluate whether coagulation biomarkers could predict arterial extravasation, especially in pelvic fracture patients with stable hemodynamics.MethodsWe studied patients with a pelvic fracture who had a systolic blood pressure above 90 mmHg and lactate level less than 5.0 mmol/L on hospital arrival. Patients were divided into two groups: those with arterial extravasation on enhanced computed tomography (CT) or angiography (extravasation [+] group) and those without arterial extravasation (extravasation [−] group). Coagulation biomarkers measured on arrival were statistically compared between the two groups. Predictive ability of arterial extravasation using coagulation biomarkers was evaluated by receiver-operating characteristic analyses provided area under the receiver-operating characteristic curves (AUROC) and diagnostic indicators with optimal cutoff point including sensitivity, specificity, positive and negative predictive values, and diagnostic odds ratio (DOR).ResultsSixty patients were analyzed. Fibrin degradation products (FDP), D-dimer, prothrombin time–international normalized ratio (PT–INR), and the ratio of FDP to fibrinogen were significantly higher in the extravasation (+) group than in the extravasation (−) group (FDP, 242 μg/mL [145–355] vs. 96 μg/mL [58–153]; D-dimer, 81 μg/mL [41–140] vs. 39 μg/mL [21–75]; PT–INR, 1.09 [1.05–1.24] vs. 1.02 [0.98–1.08]; and ratio of FDP to fibrinogen, 1.06 [0.85–2.01] vs. 0.46 [0.25–0.74]). The highest AUROC was with a ratio of FDP to fibrinogen of 0.777 (95% confidence interval, 0.656–0.898), and the highest predictive ability in terms of DOR was with a ratio of FDP to fibrinogen (sensitivity, 0.76; specificity, 0.76; DOR 9.90).ConclusionCoagulation biomarker could predict of arterial extravasation in pelvic fracture patients with stable hemodynamics.Electronic supplementary materialThe online version of this article (10.1186/s13017-019-0234-5) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers

et al. 2019

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“…In the section of the relationship between coagulation biomarkers and trauma severity the ability of FDP and D-dimer to predict trauma severity was demonstrated. Therefore, we also applied this to pelvic fracture [30]. Pelvic fracture is an independent risk factor for death after blunt trauma.…”

Section: The Prediction Of Extravasation In Pelvic Fracture Using Coagulation Biomarkersmentioning

confidence: 99%

Clinical Application of Coagulation Biomarkers

Aoki¹,

Hagiwara²,

Oshima³

2018

Biomarker - Indicator of Abnormal Physiological Process

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Coagulopathy is of intense interest in the fields of emergency medicine, with many recent studies of coagulation biomarkers for clinical use. The occurrence of disseminated intravascular coagulation (DIC) also resulted in the activation of studies about the coagulopathy. At present DIC has been admitted in many clinical conditions and many coagulation biomarkers have been studied. Fibrin degradation product (FDP) and D-dimer are one type of coagulation biomarker. A characteristic of FDP and D-dimer is the rapid and dynamic elevation of their levels when fibrinolysis occurs in several acute diseases. In this chapter, we present the clinical application of FDP and D-dimer. In trauma, FDP and -dimer have been used for the evaluation of trauma severity, to predict the likelihood of hemorrhage and to evaluate the need for the transfusion of packed red blood cells. In cardiac pulmonary arrest (CPA), FDP and D-dimer have been useful for predicting the return of spontaneous circulation. Thus, the measurement of coagulation biomarkers is useful in the diagnosis and/or treatment of trauma and CPA.

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Identification of and solution for false D‐dimer results

Zhang

et al. 2020

Clinical Laboratory Analysis

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Prediction of extravasation in pelvic fracture using coagulation biomarkers

Cited by 9 publications

References 31 publications

Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers

Prediction of arterial extravasation in pelvic fracture patients with stable hemodynamics using coagulation biomarkers

Clinical Application of Coagulation Biomarkers

Identification of and solution for false D‐dimer results

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