Traumatisés sévères : évaluation des facteurs préhospitaliers prédictifs d’une hypofibrinogénémie à l’admission

Abstract : Fibrinogen is the first clotting factor to reach a critical level in severely traumatized patients. Hypofibrinogenemia is a major independent factor of massive transfusion and mortality. OBJECTIVE: To evaluate the predictive factors of hypofibrinogenemia in severe trauma patients, including the time from trauma to hospital admission. METHODS: We performed a retrospective multicenter observational study. Trauma patients with an ISS> 15 score, admitted directly to a TRENAU Level 1 trauma center from 2012 to 2014 were admitted. They were divided into two groups: those with a normal intake of fibrinogen and those with a lowered rate, <2.0 g / L. A multiple logistic regression analysis was used to assess the predictive value of variables for a fibrinogen level <2.0 g / L: Systolic blood pressure, Heart Rate, Glasgow score (GCS), delay from trauma to hospital admission, use of amines or pre-hospital vascular filling> 1L. Results: A GCS≤8, a filling> 1l and the use of amines were predictive of a low rate of fibrinogen. There was no statistically significant difference between the "accident-hospital" period. Acute hypofibrinogenemia was significantly associated with: biological coagulopathy, high transfusion risk, longer hospital stay, higher ISS and increased mortality. Conclusion: GCS, vascular filling and amine use may be considered as predictors of hypofibrinogenemia at admission in severe traumatized patients.
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Master Thesis
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Juliette Margirier de Robert. Traumatisés sévères : évaluation des facteurs préhospitaliers prédictifs d’une hypofibrinogénémie à l’admission. Médecine humaine et pathologie. 2017. ⟨dumas-01513784⟩

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