title: Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the 'Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study'.
abstract: BACKGROUND
  ROTEM(®)/TEG(®) (rotational thromboelastometry) assays appear to be useful for the treatment of bleeding trauma patients. However, data on the prevalence and impact of abnormal ROTEM(®) assays are scarce.
  
  
  METHODS
  This is a prospective cohort study of blunt trauma patients (Injury Severity Score ≥15 or Glasgow Coma Score ≤14) admitted to Innsbruck Medical University Hospital between July 2005 and July 2008. Standard coagulation tests, antithrombin (AT), prothrombin fragments (F1+2), thrombin-antithrombin complex (TAT), and ROTEM(®) assays were measured after admission. Data on 334 patients remained for final analysis.
  
  
  RESULTS
  ROTEM(®) parameters correlated with standard coagulation tests (all Spearman r>0.5), and significant differences in mortality were detected for defined ROTEM(®) thresholds [FIBTEM 7 mm (21% vs 9%, P=0.006), EXTEM MCF (maximum clot firmness) 45 mm (25.4% vs 9.4%, P=0.001)]. EXTEM MCF was independently associated with early mortality [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.9-0.99] and MCF FIBTEM with need for red blood cell transfusion (OR 0.92, 95% CI 0.87-0.98). In polytrauma patients with or without head injury (n=274), the prevalence of low fibrinogen concentrations, impaired fibrin polymerization, and reduced clot firmness was 26%, 30%, and 22%, respectively, and thus higher than the prolonged international normalized ratio (14%). Hyperfibrinolysis increased fatality rates and occurred as frequently in isolated brain injury (n=60) as in polytrauma (n=274) (5%, 95% CI 1.04-13.92 vs 7.3%, 95% CI 4.52-11.05). All patients showed elevated F1+2 and TAT and low AT levels, indicating increased thrombin formation.
  
  
  CONCLUSIONS
  Our data enlarge the body of evidence showing that ROTEM(®) assays are useful in trauma patients. Treatment concepts should focus on maintaining fibrin polymerization and treating hyperfibrinolysis.
authors.affiliation: Clinic of Anaesthesiology and Intensive Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Tauber
authors.forename: P
authors.initials: P
authors.lastname: Innerhofer
authors.forename: R
authors.initials: R
authors.lastname: Breitkopf
authors.forename: I
authors.initials: I
authors.lastname: Westermann
authors.forename: R
authors.initials: R
authors.lastname: Beer
authors.forename: R
authors.initials: R
authors.lastname: El Attal
authors.forename: A
authors.initials: A
authors.lastname: Strasak
authors.forename: M
authors.initials: M
authors.lastname: Mittermayr
mesh_terms: D000328:Adult; D000368:Aged; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015331:Cohort Studies; D017707:Erythrocyte Transfusion; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D015995:Prevalence; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000150:complications*