Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis.

Authors: Itagaki, Y., Hayakawa, M., Maekawa, K., Saito, T., Kodate, A., Honma, Y., Mizugaki, A., Yoshida, T., Ohyasu, T., Katabami, K., and Wada, T.

Published: World Journal of Emergency Surgery January 2020

Affiliations: Emergency and Critical Care Center, Sapporo City General Hospital, 1-1 Nishi13, Kita 11, Kita-ku, Sapporo, Hokkaido 060-8604 Japan; Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan.

Abstract: BACKGROUND: Fibrinogen plays an important role in haemostasis during the early phase of trauma, and low fibrinogen levels after severe trauma are associated with haemostatic impairment, massive bleeding, and poor outcomes. Aggressive fibrinogen supplementation may improve haemostatic function, as fibrinogen levels deteriorate before other routine coagulation parameters in this setting. Therefore, we evaluated whether early administration of fibrinogen concentrate (FC) was associated with improved survival in severe trauma patients. METHODS: This single-centre retrospective study evaluated patients with severe trauma (injury severity score <16) who were admitted to our emergency department between January 2010 and July 2018. The exclusion criteria included age >18 years, cardiac arrest before emergency department arrival, cervical spinal cord injury not caused by a high-energy accident, and severe burn injuries. The FC and control groups included trauma patients who received and did not receive FC within 1h after emergency department arrival, respectively. Propensity scores were used to balance the two groups based on the trauma and injury severity score (TRISS), heart rate at emergency department admission, and age. The primary outcome was the in-hospital survival rate. RESULTS: The propensity scoring model had a c-statistic of 0.734, the Hosmer-Lemeshow chi-squared value was 7.036 (degrees of freedom = 8), and the non-significant p value of 0.533 indicated a good model fit. The propensity score matching created 31 matched pairs of patients, who had appropriately balanced characteristics. The FC group had a significantly higher in-hospital survival rate than the control group (log-rank p = 0.013). The FC group also used significantly higher amounts of red blood cells and fresh frozen plasma within 6h after emergency department admission. However, the two groups had similar transfusion amounts between 6 and 24h after emergency department admission. CONCLUSIONS: The present study revealed that early FC administration was associated with a favourable survival rate among severe trauma patients. Therefore, FC may be useful for the early management of trauma-induced coagulopathy and may improve outcomes in this setting.