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Early predictive model may be new 'weapon' against leading cause of death on battlefield
Date:10/24/2007

, International Normalized Ratio (INR, the ratio of a patient's prothrombin time to a normal, or control, sample that is used to determine the blood's tendency to clot), prothrombin time, partial thromboplastin time, hemoglobin level and platelet count.

Based on a stepwise logistic regression analysis, a hemoglobin level 11 grams/deciliter (g/dL), INR >1.5 and a penetrating injury mechanism (e.g., injuries resulting from improvised explosive devices (IEDs) and high-powered weapons), were found to be independently predictive of the need for MT. The single most predictive variable was a hemoglobin level 11 g/dL, with an odds ratio of 7.7. Researchers determined that a combination of these three variables reliably predicts the need for MT.

Dr. Schreiber added that this work is a unique addition to the literature on predictors of MT because the study population consisted primarily of young male patients with injuries sustained by IEDs and high-powered weapons, which is quite different from a typical civilian population. Despite these facts, mortality in the MT group was identical to the mortality reported by a recently published study from a large civilian center.

Researchers also found that coagulopathy (a defect in the body's blood clotting process) occurs early after injury in severely injured combat victims and is associated with the need for MT and high mortality. Mortality was 39 percent in the MT group and 1 percent in the non-MT group (p<0.001).

The primary finding of this study is that the combination of hemoglobin 11 g/dL, INR > 1.5, and a penetrating mechanism reliably predict the need for MT. Using rapid laboratory technology, these variables are available within a few minutes of the patients' arrival, allowing the treating physicians to organize the resources necessary to deal with an MT patient. Dr. Schreiber is a Lieutenant Colonel in the Unites States Army Reserve.


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Contact: Sally Garneski
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Weber Shandwick Worldwide
Source:Eurekalert

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