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Early Identification of Acute Traumatic Coagulopathy Using Clinical Prediction Tools: A Systematic Review

School of Public Health and Preventive Medicine, Monash University, Melbourne 3004, Australia
Institute for Research in Operative Medicine, University Witten/Herdecke, 51109 Cologne, Germany
Department of Traumatology, Orthopaedic Surgery and Sports Traumatology, Cologne-Merheim Medical Centre, 51109 Cologne, Germany
ANU Medical School, Australian National University, Canberra 2605, Australia
National Trauma Research Institute, Melbourne 3004, Australia
Emergency and Trauma Centre, The Alfred Hospital, Melbourne 3004, Australia
Author to whom correspondence should be addressed.
Medicina 2019, 55(10), 653;
Received: 8 June 2019 / Revised: 20 September 2019 / Accepted: 25 September 2019 / Published: 28 September 2019
(This article belongs to the Special Issue Trauma care)
Background and objectives: Prompt identification of patients with acute traumatic coagulopathy (ATC) is necessary to expedite appropriate treatment. An early clinical prediction tool that does not require laboratory testing is a convenient way to estimate risk. Prediction models have been developed, but none are in widespread use. This systematic review aimed to identify and assess accuracy of prediction tools for ATC. Materials and Methods: A search of OVID Medline and Embase was performed for articles published between January 1998 and February 2018. We searched for prognostic and predictive studies of coagulopathy in adult trauma patients. Studies that described stand-alone predictive or associated factors were excluded. Studies describing prediction of laboratory-diagnosed ATC were extracted. Performance of these tools was described. Results: Six studies were identified describing four different ATC prediction tools. The COAST score uses five prehospital variables (blood pressure, temperature, chest decompression, vehicular entrapment and abdominal injury) and performed with 60% sensitivity and 96% specificity to identify an International Normalised Ratio (INR) of >1.5 on an Australian single centre cohort. TICCS predicted an INR of >1.3 in a small Belgian cohort with 100% sensitivity and 96% specificity based on admissions to resuscitation rooms, blood pressure and injury distribution but performed with an Area under the Receiver Operating Characteristic (AUROC) curve of 0.700 on a German trauma registry validation. Prediction of Acute Coagulopathy of Trauma (PACT) was developed in USA using six weighted variables (shock index, age, mechanism of injury, Glasgow Coma Scale, cardiopulmonary resuscitation, intubation) and predicted an INR of >1.5 with 73.1% sensitivity and 73.8% specificity. The Bayesian network model is an artificial intelligence system that predicted a prothrombin time ratio of >1.2 based on 14 clinical variables with 90% sensitivity and 92% specificity. Conclusions: The search for ATC prediction models yielded four scoring systems. While there is some potential to be implemented effectively in clinical practice, none have been sufficiently externally validated to demonstrate associations with patient outcomes. These tools remain useful for research purposes to identify populations at risk of ATC. View Full-Text
Keywords: acute traumatic coagulopathy; prediction model; pre-hospital; bleeding; trauma acute traumatic coagulopathy; prediction model; pre-hospital; bleeding; trauma
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Thorn, S.; Güting, H.; Maegele, M.; Gruen, R.L.; Mitra, B. Early Identification of Acute Traumatic Coagulopathy Using Clinical Prediction Tools: A Systematic Review. Medicina 2019, 55, 653.

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