Trauma-specific revision of the Japanese Association for Acute Medicine disseminated intravascular coagulation criteria improves outcome prediction in severely injured patients.

Abstract

No universal definition of trauma-induced coagulopathy exists, and no validated scoring system accurately evaluates coagulopathy in patients with severe trauma. Although developed for sepsis and other critical illnesses, the conventional Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) score's applicability to trauma populations remains controversial. This study aimed to evaluate the JAAM DIC score's diagnostic performance in patients with severe trauma and develop a trauma-specific coagulopathy scoring system based on its original components. This retrospective study analyzed data from a multicenter trauma cohort between April 1, 2018, and March 31, 2019. Patients 18 years or older with severe trauma and an Injury Severity Score of ≥16 were included. The primary outcome was defined as all-cause in-hospital mortality. The secondary outcomes were 24-hour mortality, cause-specific in-hospital mortality (exsanguination, traumatic brain injury [TBI], and others), and massive transfusion incidence. The conventional JAAM DIC variables' predictive performance for all-cause in-hospital mortality, 24-hour mortality, death due to exsanguination, TBI-induced death, and massive transfusion occurrence were assessed using receiver operating characteristic curves. A new trauma DIC score was developed using the optimal cutoff values and compared with the conventional scores. Among 719 patients analyzed, optimal cutoff values for predicting in-hospital mortality were a prothrombin time-international normalized ratio of 1.080, fibrin degradation products of 116.0 μg/mL, and platelet count of 17.0 (×104/μL). The DIC group had higher all-cause mortality rates than the non-DIC group. The new trauma DIC score outperformed the conventional score for predicting all-cause mortality, 24-hour mortality, TBI-induced death, and massive transfusion requirements; however, both performed similarly for exsanguination-induced death. We developed a trauma-specific DIC score that outperformed the conventional score for predicting clinical outcomes in patients with severe trauma. While promising for trauma populations, external validation in various clinical settings is warranted. Multicenter Retrospective Cohort Study; Level IV.