The Influence on Morbidity and Mortality when Blood Products are Transfused using Conventional Coagulation Tests Versus TEG or ROTEM in Trauma Patients Perioperatively

Abstract: Coagulopathy in trauma patients occurs due to tissue injury, hemodilution (dilution of hematocrit and clotting factors), infusion of hypo-coagulable blood products (e.g., packed red blood cells), acidosis, hypothermia, continued blood loss, and depletion of clotting factors. The onset of coagulopathy begins with the initial tissue injury and evolves rapidly. Many factors need consideration when determining resuscitative treatment for the trauma victim. These factors include the amount of time for extraction from the field, transport time to a trauma center, associated weather, and treatment provided in route. This study compared two clinical laboratory pathways (Conventional Coagulation test and Rotational Thromboelastometry [ROTEM] whole blood assay) to determine the influence on morbidity and mortality when trauma patients received blood products perioperatively. Introduction: Coagulopathy can begin at the point of injury and is called acute coagulopathy of trauma or can be triggered in the presence of low body temperature, dilution, acidosis, and expenditure of clotting factors and is called trauma-induced coagulopathy. Coagulopathy is a critical condition and needs to be diagnosed early. Research on TEG/ROTEM whole blood assays indicates a promising future in the use of these tests and the diagnosis and therapeutic process for trauma patients. Methodology: A retrospective, case-control investigation was carried out at The Charleston Area Medical Center (CAMC) General Hospital Level 1 Trauma Center in West VA. The hypotheses tested was when ROTEM whole blood assays are used to diagnose and predict the number of blood products needed for patients receiving blunt force trauma or penetration to the abdomen, the morbidity and mortality rate will decrease. Results: The sample for the Conventional Coagulation Test consisted of 93 patients 18 years or older with an average age of 42. The sample for the TEG/ROTEM whole blood assay consisted of 43 patients 18 years or older with an average age of 44. There was no statistical significance between ROTEM and Conventional tests and ISS, age, BMI, LOS, or the number of blood products given a (p\u3e0.05). No statistical significance was found between ROTEM and Conventional tests and gender, AIS, and priority level 1 or 2 with a (p\u3e0.05). No statistical significance was found using the Fisher’s Exact test comparing ROTEM and Conventional tests and the development of CHF or Pulmonary Edema with a (p\u3e0.05). The results indicated that the mortality rate was higher among the ROTEM group and was found to be statistically significant with (p\u3c0.05) compared to the Conventional group. Discussion: CAMC General Hospital began using the ROTEM whole blood assay test on trauma patients in 2014. For this study, there were only 43 ROTEM cases that could be used compared to 100 Conventional Coagulation test cases. Future research should be conducted at CAMC General Hospital on trauma patients receiving blood transfusions and the use of ROTEM whole blood assay tests when more cases are available for comparison. Conclusion: The working hypothesis for this study was trauma patients who received blood transfusions guided by TEG/ROTEM whole blood assays received fewer blood products and had a decreased morbidity and mortality rate than those who received blood transfusions guided by Conventional Coagulation tests. Although, statistical significance was found between the mortality rate and the case group no significance was found supporting the hypothesis due to the lack of sufficient ROTEM cases