Risk factors and preliminary prediction models for trauma-induced coagulopathy and 28-day mortality in severely injured patients: a retrospective observational cohort study.
Frontiers in medicine · 2026-01-01 · Observational study
Abstract
BACKGROUND: Trauma-Induced Coagulopathy (TIC) is a critical complication in severe trauma patients associated with high mortality. Early identification is paramount for survival, yet reliable early warning indicators remain underutilized. This study aimed to identify independent predictors for TIC and mortality, and to establish robust prediction models to guide clinical decision-making. METHODS: A retrospective analysis was conducted on 128 severe trauma patients admitted to a single center. Patients were stratified into TIC (n = 44) and Non-TIC (n = 84) groups based on admission coagulation profiles. Univariate and multivariable logistic regression analyses were performed to identify risk factors. Predictive performances of the models for TIC onset and 28-day all-cause mortality were evaluated using the Area Under the Curve (AUC). RESULTS: The incidence of TIC was 34.4%. Multivariable analysis identified Shock Index (SI), time from injury to admission, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) as independent predictors of TIC. The TIC prediction model demonstrated good discriminative ability with an AUC of 0.825. Optimal cut-off values were identified as SI > 0.73 and time from injury > 23 min, serving as early warning thresholds. Furthermore, TIC was confirmed as a potent independent risk factor for mortality (OR = 5.317, 95% CI: 1.491-18.961). The prognostic model, incorporating TIC, shock status, ISS, and GCS, achieved excellent accuracy in predicting 28-day mortality with an AUC of 0.952. CONCLUSION: SI, pre-hospital time, ISS, and GCS are robust early predictors of TIC. Specifically, an SI > 0.73 and a pre-hospital time exceeding 23 min serve as critical early warning thresholds warranting immediate coagulation assessment and potential intervention. The developed models provide clinicians with practical tools for early risk stratification and mortality prediction, potentially improving outcomes in severe trauma management.
Tags
Early warning scores · Mortality & survival · Time intervals