Evaluation of Antitrombin-III in multiple traumatic patients with trauma scores in the Emergency Department

Materials and Methods
In this prospective study, thirty patients admitted to Dicle University Hospital, Department of Emergency between January 1998 - March 1999 with multiple trauma were evaluated. Patients were scored according to the Injury Severe Score (ISS) and Glasgow Coma Score (GCS) (Table 1,2). Abbreviated Injury Scale (AIS) and the injuries in the whole body systems are evaluated in calculating ISS. The ISS has six parameters with points ranging from 0 to 5. The lowest score is 0 and the highest score is 30. ISS is evaluated by the addition of the squares of the highest three AIS values. The score is in the range of 1 to 75. It is directly proportional with the mortality. For GCS; 3 is the worst score while 15 is the best one. A score of 8 or lower, corresponds to coma or severe head trauma; if the score is 9 to 12, head trauma with medium severity is indicated; if the score is 13 or higher, mild head trauma is assumed. [4,18].

The patients were divided into 3 groups according to their ISS and GCS scores:

  • Group I: patients (n=8) with severe multiple trauma and severe head trauma (ISS>25, GCS<8),
  • Group II: patients (n=8) with severe trauma and mild head trauma (ISS>25, GCS>12),
  • Group III: patients (n=14) with mild multiple trauma and mild head trauma (ISS<25, GCS>12).

After the initial examination, their respiratory and circulatory systems were examined and intubations and liquid replacement (for the patients who lose volume) were applied when needed. Full blood examinations, biochemical examinations, ECG and cranial tomography (for some cases) were done. The patients that needed to have surgical treatment were taken to the appropriate services of the hospital and continued to be followed.

Blood for test would be based to evaluation were taken intravenously from all patients at admission and three days post-trauma and also full blood with EDTA (1.8 ml, EDTA (K3); Becton Dickinson Vacutainer Systems, France) and into the PT tubes (3 ml, CIT.No-0.129M, SILIC.; Becton Dickinson Vacutainer Systems, France). They were studied by centrifuging for 10 minutes at 10000cyc/min at 2-8C in the Central Laboratory.

The level of plasma AT-III was evaluated by using Beckman AT-III diagnostic test and Beckman Array 360 System Nephelometric Centrifugal Analyzer (The components of the test are the AT-III anticore and the AT-III anticore card. Human AT-III anticore and 0.1% (w/v) sodium aside were used as conservator in 5ml of AT-III anticore.). The lower boundary for the evaluation was <5 mg/dl. The normal values (for the tubes with EDTA) are 27.7 - 38.3 mg/dl.

PT and fibrinogen level were evaluated by using the IL TEST PT-FIBRINOGEN (Instrumentation Laboratory SpA-Italy) diagnostic test and the Nephelometric method. Normal values for the PT is 10.7 - 13.0" (140 - 70%) while that of fibrinogen is 200 - 400 mg/dl. aPTT was evaluated by using the IL APTT (Instrumentation Laboratory SpA-Italy) diagnostic test and the Nephelometric method. Normal value for the aPTT is 27 - 35". Cross-reference tables were prepared by evaluating the AT-III, fibrinogen, aPTT and PT levels according to the severity of the trauma for the patients with multiple trauma.

Table 1. Glasgow Coma Score.

  Injury Score
Motor Response Can do as he/she is told 6
Localization of pain 5
Pull response to pain 4
Flexion response to pain 3
Extension response to pain 2
No response 1
Verbal Response Fully conscious 5
Conscious but blurred  4
Nonsense words 3
Nonsense voices 2
No response 1
Condition of eyes Spontaneously open     4
Opens in response to voice 3
Opens in response to pain 2
Continuously closed   1

Table 2. AIS (Abbreviated Injury Scale).

  Injury Score
Head-Neck No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5
Skin No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5
Face No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5
Thorax No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5
Abdomen No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5
Extremities No injury 0
Mild injury 1
Medium level injury 2
Severe injury, but no life risk 3
Severe injury, life risk 4
Critical  5