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Correlation of pre-hospital point-of-care INR to laboratory-based INR in acute traumatic coagulopathy.

BACKGROUND
Acute traumatic coagulopathy (ATC) is associated with increased mortality and hospital transfusion requirements. Accurate pre-hospital identification of ATC may improve outcomes by expediting care. Unlike clinical scores which may include subjective components, point of care (POC) international normalized ratio (INR) testing provides an objective value which in the non-trauma setting correlates well with laboratory INR (LABINR) results.The objective of this study was to evaluate the accuracy and ROC characteristics of pre-hospital sampled POC INR tests in trauma patients.


METHODS
Blood was drawn in the field for pre-hospital POCINR and comparative LABINR testing. Acute Traumatic Coagulopathy (ATC) was defined as LABINR31.3 and severe ATC LABINR31.5.


RESULTS
Of 137 patients included in the analysis, ATC was present in 20 patients (14.6%) and severe ATC in six (4.7%). POCINR estimated LABINR with bias of 0.036 (95%CI: -0.297-0.369). ROC analysis for severe ATC demonstrated an AUC = 0.92 (95%CI: 0.83-1.00).


CONCLUSION
Pre-hospital POCINR correlates well with for LABINR in trauma patients. It has excellent ROC characteristics for diagnosing trauma patients with an INR31.5.


LEVEL OF EVIDENCE
II/III.