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. 2013 Jun;74(6):1474-9.
doi: 10.1097/TA.0b013e3182923193.

Major burn injury is not associated with acute traumatic coagulopathy

Rommel P Lu  1 , Ai Ni, Feng-Chang Lin, Shiara M Ortiz-Pujols, Sasha D Adams, Dougald M Monroe 3rd, Herbert C Whinna, Bruce A Cairns, Nigel S Key
Affiliations

Major burn injury is not associated with acute traumatic coagulopathy

Rommel P Lu et al. J Trauma Acute Care Surg. 2013 Jun.

Abstract

Background: The pathophysiology and time course of coagulopathy after major burns are inadequately understood. Our study objectives were to determine whether acute traumatic coagulopathy (ATC) is seen in burn patients at admission and to determine the changes in international normalized ratio (INR), activated partial thromboplastin time (aPTT), platelet count (PLT), and hemoglobin (Hgb) in the first 7 days after injury.

Methods: We conducted a retrospective study of patients with burn injury of at least 15% total body surface area who presented to the University of North Carolina. Data on patient demographics, injury characteristics, and laboratory data (INR, aPTT, PLT, and Hgb) at admission and within the first 7 days after injury were recorded. We defined ATC as INR of 1.3 or greater, aPTT of 1.5 or greater times the mean normal limit, and normal PLT at admission.

Results: We studied the hematologic profile of 102 patients with burn injury of 15% to 100% total body surface area but did not identify a single patient with ATC at admission. The screening hematologic profile at admission was not influenced by burn severity. In the first 7 days after injury, the INR and aPTT were relatively preserved, while the PLT quickly recovered to baseline after an early decline and the Hgb remained stable at around 10 g/dL; all these changes occurred during the time when the burn patients had received large amounts of fluid resuscitation.

Conclusion: The screening hematologic profile of burn patients at admission is normal, and the standard screening assays do not suggest the existence of ATC at admission. While this is a relatively small study, it provides evidence to suggest that ATC is unique to trauma patients.

Level of evidence: Prognostic study, level III.

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Conflict of interest statement

Conflict of Interest:

DMM reported no conflict of interest with this submission but has relevant financial activities outside of this work. For the remaining authors, no conflicts were declared.

Figures

Figure 1
Figure 1
Histograms of admission laboratory data
Figure 2
Figure 2
Association between admission INR, total body surface area burn, and elapsed time to obtain the admission INR
Figure 3
Figure 3
Trends of individual laboratory data in the first 7 days after injury
See this image and copyright information in PMC

Comment in

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