Pulmonary Contusion on Admission Chest X-ray is Associated with Coagulopathy and Mortality in Trauma Patients

Abstract

Introduction: Trauma patients presenting with coagulopathy are four times more likely to die. After observing patients presenting with isolated severe Pulmonary Contusion (PC) on admission Chest X-ray (CXR) who were also coagulopathic, we hypothesized that patients with PC on admission CXR were more likely to be coagulopathic than other trauma patients. Methods: This was an IRB approved, single-center, retrospective cohort study of patients admitted over an 18 month period. Data were obtained from the trauma registry and medical records including demographics, laboratory values, injury severity scores, coagulation parameters and PC diagnostic modality. Patients on anticoagulants were excluded. The PC group consisted of patients diagnosed with PC by admission CXR. The control group were those patients without a PC or those diagnosed only by CT. Coagulopathy was defined as INR>1.4 or PTT>35 seconds. The PC group was further stratified into mild, moderate or severe PC. Data were analyzed with univariate analyses followed by development of a logistic regression model. Significance was set at p<0.05. Results: The PC group contained 189 subjects and controls 333. As expected ISS was higher in the PC group (25 vs 21) as was AIS chest (3 vs 1); both p<0.001. The prevalence of coagulopathy was also greater in PC (31% vs. 17%, p<0.001). After adjusting for ISS, PC patients were more likely to be coagulopathic (OR=1.76, 95% CI: 1.12-2.75) and had higher 24 hour (7% vs 3%, p=0.04) and overall mortality rates (15% vs 7%, p=0.006). The prevalence of coagulopathy increased with severity of pulmonary contusion in PC patients (Mild<Moderate<Severe). Conclusion: Pulmonary Contusion (PC) present on admission CXR in trauma patients is associated with an increased prevalence of coagulopathy on admission and mortality.

Flail chest with coagulopathy causes high mortality aggravated by acidosis and hypothermia

“…Whatever the mechanism, these individuals who present with early TIC (trauma induced coagulopathy) have a death risk that is up to four times higher. 17 Experimental bacterial models of pulmonary coagulopathy are a major source of current knowledge. In these models, the tissue factor (TF); TF-FVIIa pathway appears to be the mechanism by which pulmonary coagulation is activated.…”