Acute Traumatic Coagulopathy in Major Trauma Orthopaedic Patients at Kenyatta National Hospital

Abstract

Background: Mortality due to trauma is a major public health issue. It is among leading causes of death in persons aged between 25-44yrs. Within the first 48hrs of admission, uncontrolled haemorrhage and coagulopathy is responsible for 50% of all trauma related deaths. This early development is known as Acute Traumatic coagulopathy (ATC). It is associated with increased transfusion requirement, organs failure and high mortality rate. In Kenya, mechanisms of injuries include road traffic accidents (36.8%), falls (26.4%) and been assaulted by a person or object (20.1%). Orthopaedic related injuries were the most commonly encountered in a multisite surveillance study in four referral hospitals in Kenya . In musculoskeletal trauma patients, presence of coagulopathy at admission can be used as a predictor of complications such as sepsis, acute renal failure, multiple organs failure, need for blood transfusion and even death. In musculoskeletal trauma patients, a high Injury severity score (ISS) correlates with hypocoagulability. Previous studies have observed that ISS in musculoskeletal trauma patients can be used as a predictor of hypocoagulability complications. In many resources limited settings, coagulation profiles are not routinely done among patients with major trauma. Early identification of ATC in musculoskeletal injuries guides resuscitation protocol and prevent of ATC progression. The purpose of this study was to determine the incidence of acute coagulopathy among musculoskeletal trauma patients, and the predictive value of ISS in diagnosis of ATC. This study was also to determine the utility of injury scoring systems in predicting ATC associated outcomes among musculoskeletal trauma patients. Broad Objective: To determine the incidence of acute coagulopathy among musculoskeletal trauma patients Setting: The A & E department and orthopaedic wards at KNH Study design: Prospective analytical study of convenient patient sampling Patients and Methods: Convenient sample of 102 patients in three months. Ethical approval was obtained from KNH/ERC. Consent was obtained from each patient conveniently sampled according to the set criteria. Data collected included the patient’s demographics, mechanism of injury, duration before presenting to the hospital, type and amount of fluids received, injury severity score, coagulation profile parameters (PT,PTT, INR), full blood count and renal function test. The coagulation profile was determined at first contact with the patient during admission. In this study each patient was followed up for a duration of 14 days and monitored for occurrence of any ATC related outcome/complication. Patients were monitored by doing ..................................................................................