Timely and aggressive hemostatic therapy is known as two major measures for improving the patients' survival. Considering the important role of fibrinogen depletion in the occurrence of acute traumatic coagulopathy, timely replacement of this blood product can affect trauma patients' outcome. Nevertheless, presently there are ongoing discussions about the time to start, the amount, and the ratio of blood products transfusion (particularly fibrinogen) in trauma patients.

In this respect, some previous works suggested the use of thromboelastography (TEG) or rotational thromboelastography (ROTEM) to assess plasma fibrinogen level and the need for its transfusion.

However, these laboratory facilities are not available widely, and their use will result in significant costs compared with other simple and available clinical or laboratory tests.

Keeping in mind the above-mentioned facts, in this study, we examined the feasibility of the use of different clinical and para-clinical variables in predicting the need for fibrinogen replacement therapy in acute trauma patients.

Uncontrolled hemorrhage still remains a major cause of trauma-associated mortality. The events resulting in acute traumatic coagulopathy, particularly hypofibrinogenemia, make control of bleeding difficult. It is essential to timely predict, diagnose, and manage trauma-induced coagulopathy.

The aim of this study is to determine clinical and easily available laboratory variables that are predictive of hypofibrinogenemia in acute trauma patients.

This 2-year retrospective work examined the data of major trauma patients that were referred to Shahid Rajaee Hospital's emergency room in hemorrhagic shock condition.

Fibrinogen level was assessed for these patients on their arrival at our facility. Along with clinical and routine paraclinical variables, we evaluated the predictive value of these variables for a fibrinogen level below 100 mg/ml.

A total of 855 cases were included (females: 16.4%; and males: 83.6%) in the study. The mean ± SD age was 36 ± 17.9 years, and the mean ± SD injury severity score was 12.2 ± 9. Motor vehicle accident was the most common cause of injury.

Three factors, including arterial pH (cut off point = 7.34; area under the curve [AUC]: 0.59), base excess (cutoff point = -4.3; AUC: 0.60), and patients' gender had a significant association with the fibrinogen level under 100 mg/ml.

When three factors of pH, BE, and patients' gender are being assessed simultaneously, the AUC became 0.62 (the predictive ability improved).Variables, including arterial pH, BE level, and patients' gender have predictive value for fibrinogen transfusion in trauma.

In this respect, some previous works suggested the use of thromboelastography (TEG) or rotational thromboelastography (ROTEM) to assess plasma fibrinogen level and the need for its transfusion. However, these laboratory facilities are not available widely, and their use will result in significant costs compared with other simple and available clinical or laboratory tests.

Keeping in mind the above-mentioned facts, in this study, researchers examined the feasibility of the use of different clinical and para-clinical variables in predicting the need for fibrinogen replacement therapy in acute trauma patients.