Clinical Significance Of Different Test Methods For Diagnosis Of Trauma-induced Coagulopathy And Discussion Of Risk Factors Of Trauma-induced Coagulopathy

Objective: To explore the clinical significance of Thrombelastography(TEG)and Conventional coagulation test(RCT:DIC routine)in the diagnosis of Trauma-induced coagulopathy(TIC)and the risk factors of TIC.Methods:Traumatic patients hospitalized in Pediatric Intensive Care Unit(PICU),Shengjing Hospital Affiliated to China Medical University from December 2017 to January 2019 were divided into non-severe group(≥16),severe group(17-25)and extremely severe group(>25)according to the trauma score.Intravenous blood was collected at the time of admission/6h,12 h and 24 h,48h after injury(if the blood coagulation function is normal,the blood collection will not continue),combined with medical history,clinical manifestations,TEG or DIC routine diagnosis of TIC.To summarize the prevalence and occurrence time of TIC and the recovery time of coagulation function,and to analyze the consistency between TEG and DIC in routine diagnosis of TIC.By observing the sex,age,acidosis,mechanical ventilation,multiple injuries,blood transfusion,infusion,ISS score,GCS score,shock,MODS,hypothermia,the risk factors of TIC were summarized.Results: A total of 64 cases were collected,including 18 non-critical cases(28.1%),28 critical cases(45.8%)and 18 extremely critical cases(28.1%).TEG and DIC were used to diagnose TIC in 9 cases(14.1%)and 4 cases(6.25%)respectively.TIC could be diagnosed by TEG at 6 hours and DIC at 12 hours.Among the surviving TIC children,the ISS score was the highest 50 points,the lowest 26 points,and the recovery time of coagulation function was the longest 5 days and the shortest 24 hours.The consistency analysis of DIC and TEG in diagnosing TIC showed that Kappa = 0.579,P < 0.05.The relationship between ISS score and TIC was c2=29.11,p<0.01.Univariate analysis showed that sex,blood transfusion,transfusion,shock,MODS,mechanical ventilation,hypothermia,low age,GCS score and ISS score were all risk factors for TIC.Multivariate analysis using binary logistic regression model showed that the risk of TIC in women,hypothermia,shock and mechanical ventilation was 5.333,17.889,10.208 and 4.479 times higher than that in non-TIC.The risk of coagulation increased by 1.147 times for each increase in ISS score.The Rs of age and GCS score were less than 1,which was the protective factor of coagulation.The risk of coagulation decreased by 0.765 times when the age increased by 1 year,and 0.817 times when the GCS increased by 1 point.Conclusions: TEG is more sensitive than DIC in early diagnosis of TIC.TEG and DIC are consistent,but they can not be substituted for each other.Female,hypothermia,acidosis,infusion,blood transfusion,shock,mechanical ventilation and multiple injuries were all risk factors for TIC.MODS was considered as a non-independent risk factor for TIC in this study.