Acute burn induced coagulopathy

Burns. 2013 Sep;39(6):1157-61. doi: 10.1016/j.burns.2013.02.010. Epub 2013 Mar 14.

Abstract

Background: Acute traumatic coagulopathy is well described in the trauma population. Major burns are characterised by a similar endothelial injury and cellular hypoperfusion. These features could be a driver for an acute burn induced coagulopathy (ABIC).

Methods: Patients admitted to a regional burn centre over a 71 months period with a total body surface area burn of 30% or more were identified. The metavision electronic patient database was scrutinised for a predetermined list of demographics, interventions and admission investigations to identify any clinically significant ABIC.

Results: On admission 39.3% of the 117 patients analysed met our criteria for a coagulopathy. Of the patients with a coagulopathy, 71.7% had an elevated Prothrombin Time (PT), 2.2% had an elevated Activated Partial Thromboplastin time (APPT) and 26.1% had an elevation of both. Patients with a coagulopathy received a similar volume of fluid (p=0.08). There was a statistically significant correlation between the PT and the abbreviated burn severity index (p=0.0013, r=0.292) and serum lactate (p=0.0013, r=0.292). ABIC was an independent predictor of 28 day mortality, OR 3.42(1.11-10.56).

Conclusion: In patients with major thermal injuries a clinically significant ABIC exists. Early diagnosis and treatment of ABIC should be considered particularly in those undergoing total burn wound excision.

Keywords: Abbreviated burn severity index (ABSI); Activated partial thromboplastin time (APTT); Burn; Coagulopathy; Prothrombin time (PT).

MeSH terms

  • Abbreviated Injury Scale
  • Acute Disease
  • Adolescent
  • Adult
  • Blood Coagulation Disorders / etiology*
  • Burns / blood
  • Burns / complications*
  • Burns / mortality
  • Female
  • Fluid Therapy / adverse effects
  • Humans
  • Injury Severity Score
  • Logistic Models
  • Male
  • Middle Aged
  • Partial Thromboplastin Time
  • Prothrombin Time
  • Young Adult