Use of Viscoelastic Testing in Trauma Patients

Nicolas Chanes, LSU Health Sciences Center- New Orleans
Shyam Murali, University of Pennsylvania
Eric Winter, University of Pennsylvania
Madhu Subramanian, University of Pennsylvania
Allyson Hynes, University of Pennsylvania
Mark Seamon, University of Pennsylvania
Jeremy Cannon, University of Pennsylvania
Alison Smith, LSU Health Sciences Center- New Orleans

Description

Background: Coagulopathic trauma patients are at a three-fold higher risk of death compared to noncoagulopathic patients. However, identification and targeted treatment of coagulopathy is still being researched. Thromboelastography (TEG) may allow us to not only identify these patients, but also provide optimal transfusion to reverse coagulopathy. Methods: This was a secondary analysis of a multicenter retrospective review, which included adult patients receiving massive transfusion protocol. A numerical “TEG score” was calculated for each patient based on abnormalities in TEG alpha angle (<65 >degrees), clot time (>8.9 min), and clot strength (<55 >mm). Each abnormal value was assigned a point value of 1, with the overall TEG score range 0-3. Multiple regression was used to control confounding variables while evaluating the association between abnormal TEG values and key outcome variables, including patient mortality and blood product transfusion. Results: Abnormal TEG angle was significantly predictive of 24-hour platelet (p<0.001) and cryoprecipitate (p<0.001) transfusion requirements. Abnormal clot time similarly predicted 24- hour platelet (p<0.001) and cryoprecipitate (p=0.046) transfusion. Abnormal clot strength was significantly predictive of patient mortality (p=0.015), and 24-hour fresh frozen plasma transfusion (p=0.016). Patients with higher TEG scores had significantly increased odds of mortality, and greater PRBC, platelet, FFP, and cryoprecipitate transfusion requirements (all p<0.001). Sensitivity analysis testing additional permutations of TEG scoring values (e.g. assigning 2 points for abnormal clot time) did not yield significant enhancement of predictive power. Conclusions: Abnormal alpha angle, clot time, and clot strength were independently associated with patient outcomes, including mortality and transfusion characteristics. A composite TEG score integrating these factors strongly predicted all outcomes of interest. Further research is needed to validate the TEG score in a prospective manner.

 
Oct 13th, 12:00 AM

Use of Viscoelastic Testing in Trauma Patients

Background: Coagulopathic trauma patients are at a three-fold higher risk of death compared to noncoagulopathic patients. However, identification and targeted treatment of coagulopathy is still being researched. Thromboelastography (TEG) may allow us to not only identify these patients, but also provide optimal transfusion to reverse coagulopathy. Methods: This was a secondary analysis of a multicenter retrospective review, which included adult patients receiving massive transfusion protocol. A numerical “TEG score” was calculated for each patient based on abnormalities in TEG alpha angle (<65 >degrees), clot time (>8.9 min), and clot strength (<55 >mm). Each abnormal value was assigned a point value of 1, with the overall TEG score range 0-3. Multiple regression was used to control confounding variables while evaluating the association between abnormal TEG values and key outcome variables, including patient mortality and blood product transfusion. Results: Abnormal TEG angle was significantly predictive of 24-hour platelet (p<0.001) and cryoprecipitate (p<0.001) transfusion requirements. Abnormal clot time similarly predicted 24- hour platelet (p<0.001) and cryoprecipitate (p=0.046) transfusion. Abnormal clot strength was significantly predictive of patient mortality (p=0.015), and 24-hour fresh frozen plasma transfusion (p=0.016). Patients with higher TEG scores had significantly increased odds of mortality, and greater PRBC, platelet, FFP, and cryoprecipitate transfusion requirements (all p<0.001). Sensitivity analysis testing additional permutations of TEG scoring values (e.g. assigning 2 points for abnormal clot time) did not yield significant enhancement of predictive power. Conclusions: Abnormal alpha angle, clot time, and clot strength were independently associated with patient outcomes, including mortality and transfusion characteristics. A composite TEG score integrating these factors strongly predicted all outcomes of interest. Further research is needed to validate the TEG score in a prospective manner.