An Analysis of the Presence of Coagulopathy on Arrival to Emergency Departments in Deployed Military Treatment Facilities—In Response

This is the authors' abstract. We don't add key points for this paper.

We would like to thank CDR Sean Stuart for his letter to the editor in response to our recent publication, “An analysis of the presence of coagulopathy on arrival to emergency departments in deployed Military Treatment Facilities.”1 His letter not only demonstrates a community interest in the topic of coagulopathy in combat trauma but also correctly highlights the shortcomings within the data that we have presented. In the letter to the editor, he notes that our report relies on the international normalized ratio (INR), which potentially underreports the incidence of coagulopathy, citing reports as high as 50% from other reports that use different methods of detection, namely viscoelastic assays. First, we fully acknowledge the limitation of using the INR measurement for coagulopathy. We had initially intended to include thrombocytopenia (platelet count less than 150,000 per microliter) as another metric for identifying coagulopathy, which would have brought the incidence to 25%, however, during the peer-review process we were asked to remove this as a contributing factor because of the substantial variability across the literature in defining thrombocytopenia in trauma.2 This number may have more closely matched the incidence cited by CDR Stuart; however, it still relies on an indirect assessment of coagulopathy, as it only assesses the platelet count and not the function.