Evaluation of the capacity of the Trauma Induced Coagulopathy Clinical Score (TICCS) to identify trauma patients presenting early acute coagulopathy evaluated by thromboelatography.

Initiating Damage Control Resuscitation (DCR) as early as possible in severe trauma patients with Early Acute Coagulopathy of Trauma (EACT) is pivotal for patients’ survival. DCR that combines damage control surgery, permissive hypotension and early aggressive haemostatic resuscitation (EAHR), however implies among other things surgical and transfusion resources that are available 24H/7d in trauma centres but cannot be offered, for economic reasons, in emergency units from general hospitals.
In Belgium, in the absence of trauma centres, trauma patients are referred to general hospitals. 50 trauma patients per year are so referred to our emergency unit “diluted” in more than 65,000 non-trauma cases. This “dilution” prohibits maintaining the necessary organisation for immediate initiation of DCR preventing trauma patients with EACT to be optimally managed.
In order to allow DCR (and EAHR) in severe trauma patients with EACT at hospital entry, we have developed an easy-to-measure purely clinical score (the TICCS) aiming at “flagging” patients with EACT on the site of injury. In contrast to currently available trauma scoring systems, our score can be calculated by paramedics in less than 1 min and then communicated to the hospital allowing taking the necessary organisational measures before patient’s arrival. “Flagging” trauma patients with EACT on the site of injury and activating then the necessary resources for an immediate DCR at patient’s hospital entry could allow saving around 45  minutes in the initiation of DCR compared to the current trauma patients’ management in our emergency unit.
A prospective single-centre non-comparative non-interventional open study has been designed to validate, in approximately 100 trauma patients, the correlation between TICCS evaluated on the site of injury and thromboelastometry using TEG-ROTEM® made on a whole blood sample taken at the latest 30 min after patient’s arrival in the resuscitation room.