Predictors of early death after traumatic bleeding uncovered

Sep 4 2012

By Helen Albert, Senior medwireNews Reporter

The strongest predictors of early death after traumatic postinjury bleeding are Glasgow coma score, age, and systolic blood pressure, report researchers.

"Failure to start appropriate early management in bleeding trauma patients is a leading cause of preventable death from trauma," explain Pablo Perel (London School of Hygiene and Tropical Medicine, UK) and colleagues.

"Recent evidence that the early administration of tranexamic acid substantially reduces mortality in bleeding trauma patients further underscores the clinical importance of the timely identification of life threatening bleeding," they say.

Perel et al investigated factors predicting early (within 4 weeks of injury) death in patients with traumatic bleeding and developed a prognostic model to help predict mortality in such patients.

In total, 20,127 trauma patients in the Clinical Randomization of an Antifibrinolytic in Significant Hemorrhage (CRASH-2) trial who were at risk for or had significant bleeding within 8 hours of injury were followed up to assess factors predictive for early death and to create the prognostic model. Validation of the model was then carried out in 14,220 trauma patients from the Trauma Audit and Research Network (TARN).

Overall, 15% of patients died in the CRASH-2 trial and 12% in the TARN group. The strongest predictors for death were older age, lower Glasgow coma score, and lower systolic blood pressure.

The prognostic model also included income of geographic region (low, medium, or high), heart rate, time since injury, and type of injury.

Discrimination and calibration were achieved for the model with C statistics above 0.80 accomplished for both study cohorts.

To make the model accessible to healthcare staff, a simple chart to predict risk for death at the point of care was produced, as well as an online calculator.

"The relation between age and mortality needs further exploration," write the authors in the BMJ.

They conclude: "A better understanding of the mechanism by which age is associated with increasing mortality could lead to effective interventions to improve the outcome in this vulnerable population."

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