title: Viscoelastic clot strength predicts coagulation-related mortality within 15 minutes.
abstract: BACKGROUND
  Predicting refractory coagulopathy early in resuscitation of injured patients may decrease a leading cause of preventable death. We hypothesized that clot strength (G) measured by point-of-care rapid thrombelastography (r-TEG) on arrival in the emergency department can predict massive transfusion (MT) and coagulation-related mortality (MT-death).
  
  
  METHODS
  Trauma alerts/activations from May 2008 to September 2010 were reviewed. The variables included the following: age, sex, injury severity score (ISS), systolic blood pressure (SBP), base deficit (BD), traditional coagulation tests (international normalized ratio ([INR], partial thromboplastin time [PTT]), TEG-derived G, and blood products transfused within the first 6 hours. Independent predictors of 2 outcomes (MT [≥10 packed red blood cells units/6 h] and MT-related death) were identified using logistic regression. The individual predictive values of BD, INR, PTT, and G were assessed comparing the areas under the receiver operating characteristic curves (AUC ROC), while adjusting for age, ISS, and SBP.
  
  
  RESULTS
  Among the 80 study patients, 48% required MT, and 21% died of MT-related complications. INR, ISS, and G were independent predictors of MT, whereas age, ISS, SBP, and G were independently associated with MT-death. The predictive power for outcome MT did not differ among INR (adjusted AUC ROC = 0.92), PTT (AUC ROC = 0.90, P = .41), or G (AUC ROC = 0.89, P = .39). For outcome MT-death, G had the greatest adjusted AUC ROC (0.93) compared with the AUC ROC for BD (0.87, P = .05), INR (0.88, P = .11), and PTT (0.89; P = .19).
  
  
  CONCLUSIONS
  These data suggest that the point-of-care TEG parameter clot strength (G) provides consistent, independent prediction of MT and MT-death early in the resuscitation of injured patients.
authors: Department of Surgery, University of Colorado at Denver, Denver, CO, USA.
authors: Michael
authors: M
authors: Pezold
authors: Ernest E
authors: EE
authors: Moore
authors: Max
authors: M
authors: Wohlauer
authors: Angela
authors: A
authors: Sauaia
authors: Eduardo
authors: E
authors: Gonzalez
authors: Anirban
authors: A
authors: Banerjee
authors: Christopher C
authors: CC
authors: Silliman
mesh_terms: D000293:Adolescent; D000328:Adult; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003120:Colorado / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D013916:Thrombelastography; D014193:Trauma Centers / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality; D055815:Young Adult