Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan

Akira Endo, Atsushi Shiraishi, Yasuhiro Otomo, Shigeki Kushimoto, Daizoh Saitoh, Mineji Hayakawa, Hiroshi Ogura, Kiyoshi Murata, Akiyoshi Hagiwara, Junichi Sasaki, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Hiroyasu Ishikura, Munekazu Takeda, Naoyuki Kaneko, Hiroshi Kato, Daisuke Kudo, Takashi Kanemura, Takayuki ShibusawaYasushi Hagiwara, Shintaro Furugori, Yoshihiko Nakamura, Kunihiko Maekawa, Gou Mayama, Arino Yaguchi, Shiei Kim, Osamu Takasu, Kazutaka Nishiyama

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVES:: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN:: Retrospective observational study. SETTINGS:: Fifteen acute critical care medical centers in Japan. PATIENTS:: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 and –3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%. CONCLUSIONS:: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.

Original languageEnglish
JournalCritical Care Medicine
DOIs
Publication statusAccepted/In press - 2016 Apr 4

Fingerprint

Multicenter Studies
Observational Studies
Decision Making
Japan
Hypothermia
Hemostatic Disorders
Wounds and Injuries
Fibrin Fibrinogen Degradation Products
Acidosis
Sensitivity and Specificity
Injury Severity Score
International Normalized Ratio
Prothrombin Time
Critical Care
Body Temperature
Hospital Emergency Service
Retrospective Studies
Therapeutics

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care : A Retrospective Multicenter Observational Study in Japan. / Endo, Akira; Shiraishi, Atsushi; Otomo, Yasuhiro; Kushimoto, Shigeki; Saitoh, Daizoh; Hayakawa, Mineji; Ogura, Hiroshi; Murata, Kiyoshi; Hagiwara, Akiyoshi; Sasaki, Junichi; Matsuoka, Tetsuya; Uejima, Toshifumi; Morimura, Naoto; Ishikura, Hiroyasu; Takeda, Munekazu; Kaneko, Naoyuki; Kato, Hiroshi; Kudo, Daisuke; Kanemura, Takashi; Shibusawa, Takayuki; Hagiwara, Yasushi; Furugori, Shintaro; Nakamura, Yoshihiko; Maekawa, Kunihiko; Mayama, Gou; Yaguchi, Arino; Kim, Shiei; Takasu, Osamu; Nishiyama, Kazutaka.

In: Critical Care Medicine, 04.04.2016.

Research output: Contribution to journalArticle

Endo, A, Shiraishi, A, Otomo, Y, Kushimoto, S, Saitoh, D, Hayakawa, M, Ogura, H, Murata, K, Hagiwara, A, Sasaki, J, Matsuoka, T, Uejima, T, Morimura, N, Ishikura, H, Takeda, M, Kaneko, N, Kato, H, Kudo, D, Kanemura, T, Shibusawa, T, Hagiwara, Y, Furugori, S, Nakamura, Y, Maekawa, K, Mayama, G, Yaguchi, A, Kim, S, Takasu, O & Nishiyama, K 2016, 'Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan', Critical Care Medicine. https://doi.org/10.1097/CCM.0000000000001731
Endo, Akira ; Shiraishi, Atsushi ; Otomo, Yasuhiro ; Kushimoto, Shigeki ; Saitoh, Daizoh ; Hayakawa, Mineji ; Ogura, Hiroshi ; Murata, Kiyoshi ; Hagiwara, Akiyoshi ; Sasaki, Junichi ; Matsuoka, Tetsuya ; Uejima, Toshifumi ; Morimura, Naoto ; Ishikura, Hiroyasu ; Takeda, Munekazu ; Kaneko, Naoyuki ; Kato, Hiroshi ; Kudo, Daisuke ; Kanemura, Takashi ; Shibusawa, Takayuki ; Hagiwara, Yasushi ; Furugori, Shintaro ; Nakamura, Yoshihiko ; Maekawa, Kunihiko ; Mayama, Gou ; Yaguchi, Arino ; Kim, Shiei ; Takasu, Osamu ; Nishiyama, Kazutaka. / Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care : A Retrospective Multicenter Observational Study in Japan. In: Critical Care Medicine. 2016.
@article{f8d300e98a7e43e2a39176902658ed83,
title = "Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care: A Retrospective Multicenter Observational Study in Japan",
abstract = "OBJECTIVES:: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN:: Retrospective observational study. SETTINGS:: Fifteen acute critical care medical centers in Japan. PATIENTS:: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7{\%}, 17.5{\%}, and 15.9{\%}, respectively, and corresponding specificities of these were 96.4{\%}, 96.6{\%}, and 93.6{\%}, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 and –3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7{\%} and 66.8{\%}. CONCLUSIONS:: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.",
author = "Akira Endo and Atsushi Shiraishi and Yasuhiro Otomo and Shigeki Kushimoto and Daizoh Saitoh and Mineji Hayakawa and Hiroshi Ogura and Kiyoshi Murata and Akiyoshi Hagiwara and Junichi Sasaki and Tetsuya Matsuoka and Toshifumi Uejima and Naoto Morimura and Hiroyasu Ishikura and Munekazu Takeda and Naoyuki Kaneko and Hiroshi Kato and Daisuke Kudo and Takashi Kanemura and Takayuki Shibusawa and Yasushi Hagiwara and Shintaro Furugori and Yoshihiko Nakamura and Kunihiko Maekawa and Gou Mayama and Arino Yaguchi and Shiei Kim and Osamu Takasu and Kazutaka Nishiyama",
year = "2016",
month = "4",
day = "4",
doi = "10.1097/CCM.0000000000001731",
language = "English",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Development of Novel Criteria of the “Lethal Triad” as an Indicator of Decision Making in Current Trauma Care

T2 - A Retrospective Multicenter Observational Study in Japan

AU - Endo, Akira

AU - Shiraishi, Atsushi

AU - Otomo, Yasuhiro

AU - Kushimoto, Shigeki

AU - Saitoh, Daizoh

AU - Hayakawa, Mineji

AU - Ogura, Hiroshi

AU - Murata, Kiyoshi

AU - Hagiwara, Akiyoshi

AU - Sasaki, Junichi

AU - Matsuoka, Tetsuya

AU - Uejima, Toshifumi

AU - Morimura, Naoto

AU - Ishikura, Hiroyasu

AU - Takeda, Munekazu

AU - Kaneko, Naoyuki

AU - Kato, Hiroshi

AU - Kudo, Daisuke

AU - Kanemura, Takashi

AU - Shibusawa, Takayuki

AU - Hagiwara, Yasushi

AU - Furugori, Shintaro

AU - Nakamura, Yoshihiko

AU - Maekawa, Kunihiko

AU - Mayama, Gou

AU - Yaguchi, Arino

AU - Kim, Shiei

AU - Takasu, Osamu

AU - Nishiyama, Kazutaka

PY - 2016/4/4

Y1 - 2016/4/4

N2 - OBJECTIVES:: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN:: Retrospective observational study. SETTINGS:: Fifteen acute critical care medical centers in Japan. PATIENTS:: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 and –3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%. CONCLUSIONS:: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.

AB - OBJECTIVES:: To evaluate the utility of the conventional lethal triad in current trauma care practice and to develop novel criteria as indicators of treatment strategy. DESIGN:: Retrospective observational study. SETTINGS:: Fifteen acute critical care medical centers in Japan. PATIENTS:: In total, 796 consecutive trauma patients who were admitted to emergency departments with an injury severity score of greater than or equal to 16 from January 2012 to December 2012. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: All data were retrospectively collected, including laboratory data on arrival. Sensitivities to predict trauma death within 28 days of prothrombin time international normalized ratio greater than 1.50, pH less than 7.2, and body temperature less than 35°C were 15.7%, 17.5%, and 15.9%, respectively, and corresponding specificities of these were 96.4%, 96.6%, and 93.6%, respectively. The best predictors associated with hemostatic disorder and acidosis were fibrin/fibrinogen degradation product and base excess (the cutoff values were 88.8 and –3.05 mmol/L). The optimal cutoff value of hypothermia was 36.0°C. The impact of the fibrin/fibrinogen degradation product and base excess abnormality on the outcome were approximately three- and two-folds compared with those of hypothermia. Using these variables, if the patient had a hemostatic disorder alone or a combined disorder with acidosis and hypothermia, the sensitivity and specificity were 80.7% and 66.8%. CONCLUSIONS:: Because of the low sensitivity and high specificity, conventional criteria were unsuitable as prognostic indicators. Our revised criteria are assumed to be useful for predicting trauma death and have the potential to be the objective indicators for activating the damage control strategy in early trauma care.

UR - http://www.scopus.com/inward/record.url?scp=84962376802&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84962376802&partnerID=8YFLogxK

U2 - 10.1097/CCM.0000000000001731

DO - 10.1097/CCM.0000000000001731

M3 - Article

C2 - 27046085

AN - SCOPUS:84962376802

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

ER -