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. 2017 Aug;43(4):431-438.
doi: 10.1007/s00068-016-0756-4. Epub 2017 Jan 16.

What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan

H Koami  1 , Y Sakamoto  2 , K C Yamada  3 , T Matsuda  3 , J Nishi  3 , K Nakayama  3 , R Sakurai  3 , M Ohta  3 , H Imahase  3 , M Yahata  3 , M Umeka  3 , T Miike  3 , F Nagashima  3 , T Iwamura  2 , S Inoue  4
Affiliations

What factor within the Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria is most strongly correlated with trauma induced DIC? A retrospective study using thromboelastometry in a single center in Japan

H Koami et al. Eur J Trauma Emerg Surg. 2017 Aug.

Abstract

Purpose: The diagnostic criteria for disseminated intravascular coagulation (DIC) established by the Japanese Association for Acute Medicine (JAAM) is able to diagnose DIC accurately and promptly. The aim of this retrospective study is to evaluate the degree of association between each parameter of JAAM DIC criteria and the diagnosis of trauma induced DIC (T-DIC) utilizing thromboelastometry (ROTEM).

Methods: Trauma patients transported to our hospital with ROTEM performed in the emergency department between January 2013 and December 2015 were enrolled in this study. We evaluated (1) the characteristics of T-DIC, (2) the relationships between T-DIC and each parameter of the JAAM DIC criteria and (3) the diagnostic accuracies of each parameter for T-DIC by statistical measurement.

Results: All 72 patients (21 T-DIC and 51 control) were included in primary analysis. T-DIC was significantly related to younger age, more severe trauma scores, more cases of massive transfusions, and remarkable coagulation abnormality detected by standard coagulation tests. In the cases of T-DIC, ROTEM showed longer clotting time, lower acceleration, lower clot firmness, and inhibited fibrinolysis in EXTEM/INTEM. Within the JAAM DIC score, PT-INR ≥1.2 was the most accurate factor for T-DIC diagnosis; sensitivity 60.0%, specificity 100.0%, and accuracy 88.7%. PT-INR ≥1.2 was statistically correlated with the JAAM DIC score (p < 0.001, r = 0.709). The univariate analysis based on 1.2 of PT-INR indicated statistical differences in most categories of ROTEM, which is similar to analysis performed for the presence and absence of T-DIC.

Conclusions: Among JAAM DIC criteria, the PT-INR ≥1.2 was the most accurate factor for both the diagnosis of T-DIC and the evaluation of its severity.

Keywords: DIC; JAAM DIC score; PT-INR; Thromboelastometry; Trauma.

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Conflict of interest statement

Hiroyuki Koami, Yuichiro Sakamoto, Kosuke Chris Yamada, Tomoya Matsuda, Junpei Nishi, Kento Nakayama, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura and Satoshi Inoue have no conflict of interest.

Figures

Fig. 1
Fig. 1
Scheme of this study
Fig. 2
Fig. 2
Study design
Fig. 3
Fig. 3
Spearman correlation analysis between PT-INR and JAAM DIC score
Fig. 4
Fig. 4
The thromboelastometric abnormalities associated with either T-DIC (JAAM DIC score ≥4 pts) or each parameter of the JAAM DIC criteria including PT-INR ≥1.2, SIRS ≥3 pts, PLT <8 × 104/µL, PLT <12 × 104/µL, FDP ≥25 µg/mL, FDP ≥10 µg/mL
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