Thrombelastography Parameters versus Classical Coagulation Profile in Trauma Patients: a Retrospective Study

The West Virginia University Guide to the Preparation of Masters Theses Abdulraouf Y. Lamoshi Thrombelastography Parameters versus Classical Coagulation Profile in Trauma Patients: a Retrospective Study Background: Thrombelastography (TEGTM, Hemoscope, Niles, IL) is increasingly utilized. As TEG depicts overall coagulation it may be more comprehensive and capable to detect any coagulation abnormalities in comparison to classical coagulation tests (CCT: PT, PTT, INR, platelets). Traumatic brain injury (TBI) is thought to contribute to coagulopathy. The primary aim was to compare TEG parameters of TBI vs. Non-TBI patients. The secondary aim was to identify TEG vs. CCT parameters associated with outcome (mortality, need for transfusion, length of stay).;Methods: This is a cross sectional retrospective observational study of 142 patients (full trauma team activations only) admitted to a university based, Level 1 trauma center. TEG and CCT were collected on admission. Citrated Kaolin samples were utilized. Data was analyzed by a biostatistician using JMP V10.;Results: 142 patients (pts), 44 (31%) women and 98 (69%) men. 48 pts had TBI and 94 pts were NTBI. Overall mortality was 20.4% (45.8% TBI vs. 7:4% NTBI). There were no significant associations between TEG or CCT parameters and ISS, scene vs. transfer, hospital LOS, or ventilator days. There was no difference between the TBI and NTBI groups in terms of TEG or CCT parameters. Variables found to be associated with mortality were K (p = 0:0118) and age (p = 0:0057). MA was the only parameter (TEG or CCT) associated with need for transfusion of PRBC (p= 0.0377). PRBC transfusion was given in 94% of 16 patients with an MA ≤ 57:4 (1-4 units in 44% and ≥ 4 units in 50%). Platelet transfusion was given in 89% of 9 patients who have MA ≤ 58:1. FFP transfusion was given in 80% of 15 patients who have R ≥ 5.8. Decreased MA (p = 0:0003), ↓ K (p = 0:0154), ↑ PT (p = 0:0015), and ↑ INR (p = 0:0014) are significantly associated with FFP transfusion. K value is significantly associated with mortality (p = 0:0118) and hypotension ( p = 0:0172).;Conclusions: TEG parameters are potentially useful as means to rapidly diagnose coagulopathy and predict transfusion in trauma pts. Independently, presence of TBI does not cause a detectable coagulopathy. MA is best single indicator for PRBC and/or FFP transfusion in trauma patients. TEG analysis is more efficient than the classical parameters in detecting patients who will need PRBC and FFP transfusion