Articles

The Coagulopathy-Predicting Factors In Acute Trauma Patients Using The Generalized Estimation Equations Model

Abstract

Introduction: Coagulation disorder is one of the major phenomena following the trauma which can
deteriorate the condition of the patients. The aim of this study is to determine some factors predicting the
incidence of coagulation disorder among acute trauma patients.
Methods: The generalized estimation equations were used to determine the predictors of blood
coagulation disorders in a sample of 736 people over 16 years of age with acute trauma in Shahid Rajaei
Hospital in Shiraz. The response variable was converted based on PT, PTT, INR, and fibrinogen level
criteria as a two-state variable (with/without coagulation disorder). In the data analysis, the correlation of
the coagulation disorder was considered in the first and second stages.
Results:The prevalence of coagulation disorders (mild, moderate and severe) was 19% in two stages and
coagulation disorders (moderate and severe) was 7.5%. Motor vehicle accident was the most common
cause of injury.The variables of blood sugar, diastolic blood pressure, pH, and sodium had a significant
effect on coagulation disorders (mild, moderate, and severe). Moreover, blood phosphorus, age, and
pupillary reflex had a significant effect on coagulation disorders (moderate and severe).
Conclusion: Predictors of coagulation disorders (mild-moderate-severe) include blood sugar, diastolic
blood pressure, pH, and sodium. Moreover, blood phosphorus, age, and pupil reflex are predictors of
moderate and severe coagulopathy. this model that taking into account the exchangeable correlation of
first- and second-stage coagulopathy had a better fit than the model ignoring this correlation.

References
1. Hunt BJ. Bleeding and coagulopathies in critical care. New England Journal of Medicine. 2014;370(9):847-59.
2. Levi M, Opal SM. Coagulation abnormalities in critically ill patients. Critical care. 2006;10(4):222.
3. Chakraverty R, Davidson S, Peggs K, Stross P, Garrard C, Littlewood T. The incidence and cause of coagulopathies in an
intensive care population. British journal of haematology. 1996;93(2):460-3.
4. Brohi K, Cohen MJ, Davenport RA. Acute coagulopathy of trauma: mechanism, identification and effect. Current opinion in critical care. 2007;13(6):680-5.
5. Naseri P, Majd HA, Kariman N, Sourtiji A. Comparison of generalized estimating equations (GEE), mixed effects models (MEM) and repeated measures ANOVA in analysis of menorrhagia data. Journal of Paramedical Sciences. 2016;7(1):32-40.
6. Jiang J. Linear and generalized linear mixed models and their applications: Springer Science & Business Media; 2007
7. Paydar S, Ahmadi A, Dalfardi B, Shakibafard A, Abbasi H, Bolandparvaz S. Clinical and economic effects of selective radiological evaluation of high-energy trauma patients: a prospective experience of a level 1 busy trauma centre. Emerg Medical Journal. 2015;32(7):535-8.
8. Kashefi P, Abbasi S, Jahangiri MG. The relationship between acidosis and coagulopathy in patients admitted to the intensive care unit. 2017.[Persian]
9. Cui J. QIC program and model selection in GEE analyses. The Stata Journal. 2007 Jun;7(2):209-20.
10. Halekoh U, Højsgaard S, Yan J. The R package geepack for generalized estimating
equations. Journal of Statistical Software. 2006 Jan 1;15(2):1-1.
11. Liu LL. Acid-base balance and blood gas analysis. In: Miller RD, Pardo MC, editors. Basics of anesthesia. 6th ed. Philadelphia, PA: Saunders; 2011. p. 334-47.
12. Thorn S, Güting H, Maegele M, Gruen RL, Mitra B. Early Identification of Acute Traumatic Coagulopathy Using Clinical Prediction Tools: A Systematic Review. Medicina. 2019 Oct;55(10):653.
13. Kimura Y, Kimura S, Sumita S, Yamakage M. Predictors of hypofibrinogenemia in blunt trauma patients on admission. Journal of anesthesia. 2015;29(2):242-8
Files
IssueVol 8 No 4 (2022) QRcode
SectionArticles
DOI https://doi.org/10.18502/jbe.v8i4.13351
Keywords
Coagulopathy, Trauma, Generalized Estimation Equations

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Montazeri Z, Kheiri S, Paydar S, Sedehi M. The Coagulopathy-Predicting Factors In Acute Trauma Patients Using The Generalized Estimation Equations Model. JBE. 2022;8(4):372-378.