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Peltan, Ithan D.; Watkins, Timothy R.

doi:10.1097/ccm.0000000000001526

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“…However, startup costs, assay system interchangeability and reliability issues, and particularly the absence of a consensus outcome-linked viscoelastic ATC definition pose barriers to the application of viscoelastic assays in clinical care and research outside high-volume, high-resource trauma centers [20, 57, 59, 60]. Because the PACT score accelerates ATC risk stratification relative to viscoelastic assays and is applicable in the settings without access to these tests where most trauma patients receive their initial care, we believe the PACT score has a role in ATC research and, eventually, in clinical care.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a prehospital prediction model for acute traumatic coagulopathy

et al. 2016

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BackgroundAcute traumatic coagulopathy (ATC) is a syndrome of early, endogenous clotting dysfunction that afflicts up to 30% of severely injured patients, signaling an increased likelihood of all-cause and hemorrhage-associated mortality. To aid identification of patients within the likely therapeutic window for ATC and facilitate study of its mechanisms and targeted treatment, we developed and validated a prehospital ATC prediction model.MethodsConstruction of a parsimonious multivariable logistic regression model predicting ATC — defined as an admission international normalized ratio >1.5 — employed data from 1963 severely injured patients admitted to an Oregon trauma system hospital between 2008 and 2012 who received prehospital care but did not have isolated head injury. The prediction model was validated using data from 285 severely injured patients admitted to a level 1 trauma center in Seattle, WA, USA between 2009 and 2013.ResultsThe final Prediction of Acute Coagulopathy of Trauma (PACT) score incorporated age, injury mechanism, prehospital shock index and Glasgow Coma Score values, and prehospital cardiopulmonary resuscitation and endotracheal intubation. In the validation cohort, the PACT score demonstrated better discrimination (area under the receiver operating characteristic curve 0.80 vs. 0.70, p = 0.032) and likely improved calibration compared to a previously published prehospital ATC prediction score. Designating PACT scores ≥196 as positive resulted in sensitivity and specificity for ATC of 73% and 74%, respectively.ConclusionsOur prediction model uses routinely available and objective prehospital data to identify patients at increased risk of ATC. The PACT score could facilitate subject selection for studies of targeted treatment of ATC.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1541-9) contains supplementary material, which is available to authorized users.

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