J Korean Soc Emerg Med.  2018 Oct;29(5):430-436. 10.0000/jksem.2018.29.5.430.

Initial D-dimer level as early prognostic tool in blunt trauma patients without significant brain injury

• Sohn SW
• Lee JB
• Jin YH
• Jeong TO
• Jo SO
• Lee JM
• Yoon JC
• Kim SE

• KMID: 2435467
• DOI: http://doi.org/10.0000/jksem.2018.29.5.430

Abstract

OBJECTIVE
The purpose of this study was to evaluate whether or not the d-dimer level indicating hyperfibrinolysis could be a predictor of early poor outcome (massive transfusion, death within 24 hours) associated with trauma-induced coagulopathy in blunt trauma without significant brain injury.
METHODS
This study was a retrospective observational study using 516 blunt trauma patients without significant brain injury. The poor outcome group, including patients receiving massive transfusion and those who died within 24 hours, consisted of 33 patients (6.4%). The variables were compared between the poor outcome group and good outcome group, and logistic regression analysis was performed using statistically significant variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the poor outcome prediction ability of the initial d-dimer level.
RESULTS
The poor outcome group showed more serious anatomical, physiological, and laboratory data than the good outcome group. In the ROC curve analysis for evaluation of the poor outcome prediction of the d-dimer level, the area under the curve value was 0.87 (95% confidence interval [CI], 0.84-0.90) while the cut-off value was 27.35 mg/L. In the logistic regression analysis, the high d-dimer level was shown to be an independent predictor of poor outcome (adjusted odds ratio, 14.87; 95% CI, 2.96-74.67).
CONCLUSION
The high d-dimer level (>27.35 mg/L) can be used as a predictor for the poor outcome of patients with blunt trauma without significant brain injury.

Keyword

Multiple trauma; Blunt injury; D-dimer; Death; Blood transfusion

MeSH Terms

Blood Transfusion
Brain Injuries*
Brain*
Humans
Logistic Models
Multiple Trauma
Observational Study
Odds Ratio
Retrospective Studies
ROC Curve
Wounds, Nonpenetrating