Development of a novel disseminated intravascular coagulation scoring system for severe trauma patients: A secondary data analysis of J-OCTET2 study

Introduction: The utility of the conventional JAAM disseminated intravascular coagulation (DIC) scoring system has been reported in patients with thrombotic phenotype DIC, as sepsis. However, its effectiveness in severe trauma patients with fibrinolytic coagulopathy remains controversial.

Objectives: The aim of this study was to devise a scoring system for trauma induced coagulopathy (TIC) that is more accurate in predicting than the conventional JAAM DIC scores.

Material &Methods: We analyzed the data from the J-OCTET2 study, which was a retrospective multicenter registry study including the adult trauma patients with Injury Severity Score ≥16. We modified the cutoff value for each variable of conventional JAAM DIC scores based on a previous study, and built the new DIC scores (Table). A new DIC diagnosis was set at 4 points or more. The primary outcome was defined as in-hospital mortality. The secondary outcome was the incidence of massive transfusion (RBC ≥ 10 units within 24 hours). Patients' characteristics and outcomes were compared between the DIC and non-DIC group based on the new DIC scores. Furthermore, we evaluated the AUCs of the conventional JAAM DIC scores and the new DIC scores for in-hospital mortality.

Results: We analyzed 719 severe trauma patients. In-hospital morality in the DIC group was higher than in the non-DIC group (22.5 % vs. 2.4 %, p < 0.001). The frequency of the massive transfusion in DIC group was higher than that in non-DIC group. (27.6% vs. 9.4%, p < 0.001). The AUC for predicting in-hospital mortality using the new DIC scores was higher than that of the conventional JAAM DIC scores (0.855 vs. 0.784, p < 0.001).

Conclusion: We developed a new DIC scoring system for TIC, which was more accurate than the conventional JAAM DIC scores in severe trauma patients. Further studies elucidating the cause of our result are needed in order to develop the clinical application.

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