Validation of the Japanese Association for Acute Medicine-2 disseminated intravascular coagulation criteria to predict critical bleeding in patients with trauma: A nationwide cohort study in Japan.
Thrombosis research · 2025-11-07 · Observational study
Abstract
BACKGROUND: Trauma-induced coagulopathy (TIC) significantly impacts trauma prognosis, necessitating early intervention. The Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria are one of the indicators for TIC, and modified criteria, JAAM-2 DIC criteria, have recently been proposed. We aimed to investigate the predictive ability of the JAAM-2 DIC criteria and its components for critical bleeding during the acute trauma phase. METHODS: This retrospective observational study used a nationwide Japanese database, including 2.7 million patients admitted between 2014 and 2023. We included adult inpatients transported by emergency medical services due to trauma. The JAAM-2 DIC scores on admission were calculated based on platelet count, prothrombin time-international normalized ratio (PT-INR), and fibrinogen/fibrin degradation products (FDP). The primary endpoint was critical bleeding, defined as a composite of death within 24-h or massive transfusion (receiving ≥10 units of red blood cells transfusion within 2 days). We investigated the relationship between the JAAM-2 DIC score, its components, and outcomes using the area under the receiver operating characteristic curve (AUC). RESULTS: Among the 10,834 patients with trauma, 1.7 % had critical bleeding. The JAAM-2 DIC score had an AUC of 0.802, with PT-INR showing the highest AUC of 0.836 among its components. The FDP score distribution was more irregular than the others, weakening the JAAM-2 DIC score's association with prognosis. CONCLUSION: The JAAM-2 DIC criteria can predict critical bleeding in trauma. Identifying and revising FDP scoring issues in JAAM-2 DIC criteria for trauma improved AUC for predicting critical bleeding.