VERIFICATION OF CONVENTIONAL CRITERIA OF THE "LETHAL TRIAD" AND DEVELOPMENT OF NOVEL CRITERIA AS AN INDICATOR OF DECISION MAKING

Abstract

Objective : To evaluate the utility of the conventional lethal triad as the indicator for damage control strategy and to develop a novel criteria in patients with severe trauma. Design : A retrospective multicenter observational study. Patients : A total of 796 trauma patients with an ISS≥16 in a year of 2012 were enrolled. Results : The sensitivity to predict 28–day mortality of conventional criteria (PT–INR>1.5, pH<7.2, body temperature<35°C) was low and the specificity was remarkably high. Taking accuracy to predict outcome, adequate cut off value, and impact on the outcome of each parameters within the flame of triad into account, we developed the novel criteria defined by fibrinolytic disorder (FDP>90μg/ml) as major criterion, and acidosis (BE<–3mEq/L) and hypothermia (Body temperature<36°C) as minor criteria. When a patient met a major criterion or two minor criteria, the sensitivity and specificity to predict 28–day mortality were 81% and 67%, respectively. Conclusion : The conventional criteria was not suitable as a therapeutic indicator for damage control strategy in current clinical practice. The novel criteria improved sensitivity, while maintaining specificity, and assumed to have the potential to be the objective indicator to activate damage control strategy in early phase of trauma management.