Patient selection:
(1) age range 15 to 65 years
(2) severe Injury Severity Score (mean 54)
(3) massive transfusion (> 12 packed red blood cell units in first 12 hours; average total transfusion was 23 units)
(4) excluded if head injury or if significant comorbid medical condition were present
Risk factors for coagulopathy:
(1) hypothermia < 34°C
(2) acidosis (pH < 7.15)
The coagulopathy that developed in the setting of severe hypothermia and/or acidosis occurred despite adequate plasma and platelet replacement. It was characterized by:
(1) continued blood oozing despite attempts to control
(2) recurrence after initial hemostasis
(3) oozing from needle puncture sites
(4) mucosal bleeding
Risk factors for death:
(1) penetrating trauma
(2) more transfusions of packed red blood cells (>= 20 units)
(3) severe acidosis
(4) severe hypothermia
(5) coagulopathy not associated with inadequate plasma and FFP replacement for the massive transfusion
NOTE: I did not see a discussion on DIC, lactic acidosis, cryoprecipitate or use of blood warmers in the patients.
