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Critical Care
Published in: Critical Care 1/2024

Open Access 01-12-2024 | Shock | Research

Development and validation of the tic score for early detection of traumatic coagulopathy upon hospital admission: a cohort study

Authors: Louis Brac, Albrice Levrat, Charles-Hervé Vacheron, Pierre Bouzat, Tristan Delory, Jean-Stéphane David

Published in: Critical Care | Issue 1/2024

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Abstract

Background

Critically injured patients need rapid and appropriate hemostatic treatment, which requires prompt identification of trauma-induced coagulopathy (TIC) upon hospital admission. We developed and validated the performance of a clinical score based on prehospital resuscitation parameters and vital signs at hospital admission for early diagnosis of TIC.

Methods

The score was derived from a level-1 trauma center registry (training set). It was then validated on data from two other level-1 trauma centers: first on a trauma registry (retrospective validation set), and then on a prospective cohort (prospective validation set). TIC was defined as a PTratio > 1.2 at hospital admission. Prehospital (vital signs and resuscitation care) and admission data (vital signs and laboratory parameters) were collected. We considered parameters independently associated with TIC in the score (binomial logistic regression). We estimated the score’s performance for the prediction of TIC.

Results

A total of 3489 patients were included, and among these a TIC was observed in 22% (95% CI 21–24%) of cases. Five criteria were identified and included in the TIC Score: Glasgow coma scale < 9, Shock Index > 0.9, hemoglobin < 11 g.dL−1, prehospital fluid volume > 1000 ml, and prehospital use of norepinephrine (yes/no). The score, ranging from 0 and 9 points, had good performance for the identification of TIC (AUC: 0.82, 95% CI: 0.81–0.84) without differences between the three sets used. A score value < 2 had a negative predictive value of 93% and was selected to rule-out TIC. Conversely, a score value ≥ 6 had a positive predictive value of 92% and was selected to indicate TIC.

Conclusion

The TIC Score is quick and easy to calculate and can accurately identify patients with TIC upon hospital admission.
Appendix
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Metadata
Title
Development and validation of the tic score for early detection of traumatic coagulopathy upon hospital admission: a cohort study
Authors
Louis Brac
Albrice Levrat
Charles-Hervé Vacheron
Pierre Bouzat
Tristan Delory
Jean-Stéphane David
Publication date
01-12-2024
Publisher
BioMed Central
Keywords
Shock
Shock
Published in
Critical Care / Issue 1/2024
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-024-04955-7

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