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

The authors developed and validated a prehospital prediction model for acute traumatic coagulopathy (ATC). Eventually, such a score will be useful to aid identification of patients with ATC, either to initiate and guide timely therapeutic interventions or to enrol patients in studies aiming to identify the mechanisms of ATC or to evaluate targeted treatments.

ATC was defined as an admission INR >1.5. Data from 1963 severely injured patients (Oregon, USA) were used to construct the Prediction of ATC (PACT) score. The score was validated in another 285 severely injured patients (Seattle, WA, USA). The final PACT score incorporated age, injury mechanism (non motor vehicle or bicycle accident), prehospital shock index, Glasgow coma score, prehospital CPR and endotracheal intubation. The score had a specificity for ATC of 73% and a specificity of 74%. Among those with a positive PACT score (≥196), 19 of 87 had a coagulopathy while 191 of 198 with a PACT score <196 were correctly identified as not having a coagulopathy in the validation cohort. Thus, the instrument is not perfect but it does help identify a subset of patients at greater risk of ATC. The rapid identification of patients at high risk of ATC will help initiate therapy within minutes of injury. For researchers, the score may reduce the heterogeneity of the trauma patient population, for example avoiding the inclusion of a large number of patients less at risk of coagulopathy in a study on novel treatments for ATC. – Jean-François Hardy