Evaluation of Antitrombin

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

Statistical Analysis
Statistical analysis of the study was done by using the SPSS 6.0 software. For the comparison of two matched groups, Wilcoxon Matched-Pairs Signed-Ranks Test; for the unmatched samples, non-parametric Mann-Whitney U test; for the comparison of multiple invariant samples, Variance Analysis, One-way ANOVA, Multiple Range Test, Modified LSD (Bonferroni) Test; for the comparison of categorical variables, χ²; for the correlation analysis, Pearson Correlation Test; for the linear relationships, Multiple Regression Analysis were used. P<0.05 was considered to be significant.

Results
When we evaluate the demographic data for our patient group, we observe that the mean age for the 30 patients is 25±19, while the range is 4 - 74 years (Table 3). 24 of them are men and 6 of them are women, while men/women ratio is 4/1. 33.3% of them are between 0 - 14 years of age, 53.3% of them are between 14 - 20 years of age 80% of them are between 20 - 35 years of age. Most of the patients were treated and chased in the Emergency (n: 13) and Brain Surgery (n: 11) Services; while the others were chased in the General Surgery (n: 4), Orthopedics (n: 1) and Pediatric Surgery (n: 1) Services (Table 3).

Table 3. General Sociodemographic Data of the Patients.

Group I

(n)

Group II
(n)
Group III
(n)
Total
(n)

City where the patient came from

Diyarbakır 5 3 9 17

Şanlıurfa - 1 1 2

Mardin 1 3 3 7

Batman 2 1 1 4

Reason of Trauma

Injury by gun - - 1 1

Traffic accident 7 6 7 20

Crumble 1 1 4 6

Others - 1 2 3

Service in the Hospital

Emergency 2 6 5 13

Brain Surgery 5 1 5 11

General Surgery 1 1 2 4

Orthopedia - - 1 1

Pediatric Surgery - - 1 1

Exitus/Alive

Exitus 2 - 1 3

Alive 6 8 13 27

Reason of Exitus

Intracranial bleeding 2 - - 2

Postoperative complication - - 1 1

Gender

Male 7 6 11 24

Female 1 2 3 6

Total 8 8 14 30

The first two of the three patient that had been exitus, among the total of 30 patients, were the patients that were taken to the Brain Surgery Service and they had been exitus because of intra cranial bleeding. They were 12 and 70 years old. Their ISS values were 25 and 39, while GCS of were 8 and 5 respectively. The third patient that had been exitus was a 35 year old man who was in Group III and had been exitus on the first day postoperatively while he was in the Orthopedia Service. His ISS score was 22, GCS score was 15 and the other hematological parameters were normal. All three patients were taken to the Emergency Service 120 minutes after being exitus (Table 4).

Table 4. Trauma Scores, Ages and Time Taken to Attempt the Emergency Service of the Patients According to the Groups.

	Group I	Group II	Group III	P
GLASGOW	6±1	14±2	15±1	> 0.0001
ISS	38±9	37±6	15±6	> 0.0001
Time (minutes)	146±66	341±423	390±351	> 0.05
Age (years)	19.7±20.9	26.5±12.6	27.7±21.9	> 0.05

Most of the trauma reasons of the patients were traffic accident (n: 20). More than half of them came from Diyarbakir (n: 17). The rest of them came from the surrounding cities of Diyarbakir (Sanliurfa, Mardin, Batman) (Table 3). The mean time that had taken to take them to the Emergency Service is 312±332 minutes (minimum of 30, maximum of 1080 minutes). 56.7% of the patients arrived at the hospital in the first 120 minutes. The percentage of the patients that arrived at the hospital in the first one hour is only 10.

On first day of the trauma, it was found to be a strong negative correlation between the AT-III level and the ISS score (r=0.49, P=0.005; Multiple Regression Analysis T=-3.9, P=0.005, Beta=-0.78, 95% CI=0.94; -0.29). But there was no correlation between the ISS and the first day fibrinogen, thrombocyte count, PT, aPTT and between the third day AT-III, fibrinogen, thrombocyte count, PT, aPTT levels and the Glasgow Coma score. Mean Glasgow score was 12±4 and the ISS score was 27±14. Intravenous liquid was not applied to the 11 patients before attempting to the Emergency Service, while at least 500ml of IV liquid was given to the 19 patients before attempting to the Emergency Service.

There was no significant difference between the hematological parameters of the patients except PT (Table 5). When the hematological parameters were compared in accordance with the group base, it was observed that AT-III levels of Group II patients were lower than that of Group I and III patients (Table 6). When the admission and the third posttraumatic day parameter levels were compared, it was observed that AT-III level was low on the admission day for the Group I and II patients, while it had increased on the third posttraumatic day (Table 7).