J Korean Med Sci.  2018 Jan;33(3):e21. 10.3346/jkms.2018.33.e21.

Prognostic Performance Evaluation of the International Society on Thrombosis and Hemostasis and the Korean Society on Thrombosis and Hemostasis Scores in the Early Phase of Trauma

Affiliations
  • 1Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Korea. ggodhkekf@hanmail.net

Abstract

BACKGROUND
Disseminated intravascular coagulation (DIC) contributes to poor outcome in the early phase of trauma. We aimed to analyze and compare the prognostic performances of the International Society on Thrombosis and Hemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH) scores in the early phase of trauma.
METHODS
Receiver operating characteristics analysis was used to examine the prognostic performance of both scores, and multivariate analysis was used to estimate the prognostic impact of the ISTH and KSTH scores in the early phase of trauma. The primary outcome was 24-hour mortality and the secondary outcome was massive transfusion.
RESULTS
Of 1,229 patients included in the study, the 24-hour mortality rate was 7.6% (n = 93), and 8.1% (n = 99) of patients who received massive transfusions. The area under the curves (AUCs) of the KSTH and ISTH scores for 24-hour mortality were 0.784 (95% confidence interval [CI], 0.760-0.807) and 0.744 (95% CI, 0.718-0.768), respectively. The AUC of KSTH and ISTH scores for massive transfusion were 0.758 (95% CI, 0.734-0.782) and 0.646 (95% CI, 0.619-0.673), respectively. The AUCs of the KSTH score was significantly different from those of the ISTH score. Overt DIC according to KSTH criteria only, was independently associated with 24-hour mortality (odds ratio [OR], 2.630; 95% CI, 1.456-4.752). Only the KSTH score was independently associated with massive transfusion (OR, 1.563; 95% CI, 1.182-2.068).
CONCLUSION
The KSTH score demonstrates a better prognostic performance for outcomes than the ISTH score in the early phase of trauma.

Keyword

Trauma; Prognosis; Disseminated Intravascular Coagulation; Scoring

MeSH Terms

Area Under Curve
Dacarbazine
Disseminated Intravascular Coagulation
Hemostasis*
Humans
Mortality
Multivariate Analysis
Prognosis
ROC Curve
Thrombosis*
Dacarbazine
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