title: Thromboelastometric (ROTEM) findings in patients suffering from isolated severe traumatic brain injury.
abstract: Severe traumatic brain injury (sTBI) is often accompanied by coagulopathy and an increased risk of bleeding. To identify and successfully treat bleeding disorders associated with sTBI, rapid assessment of coagulation status is crucial. This retrospective study was designed to assess the potential role of whole-blood thromboelastometry (ROTEM(®), Tem International, Munich, Germany) in patients with isolated sTBI (abbreviated injury scale [AIS](head) ≥3 and AIS(extracranial) <3). Blood samples were obtained immediately following admission to the emergency room of the Trauma Centre Salzburg in Austria. ROTEM analysis (EXTEM, INTEM, and FIBTEM tests) and standard laboratory coagulation tests (prothrombin time index [PTI, percentage of normal prothrombin time], activated partial thromboplastin time [aPTT], fibrinogen concentration, and platelet count) were compared between survivors and non-survivors. Out of 88 patients with sTBI enrolled in the study, 66 survived and 22 died. PTI, fibrinogen, and platelet count were significantly higher in survivors (p<0.005). Accordingly, aPTT was shorter in this group (p<0.0001). ROTEM analysis revealed shorter clotting times in extrinsically activated thromboelastometric test (EXTEM) and intrinsically activated thromboelastometric test (INTEM) (p<0.001), shorter clot formation times in EXTEM and INTEM (p<0.0001), and higher maximum clot firmness in EXTEM, INTEM, and FIBTEM (p<0.01) in survivors compared with non-survivors. Logistic regression analysis revealed extrinsically activated thromboelastometric test with cytochalasin D (FIBTEM) MCF and aPTT to have the best predictive value for mortality. According to the degree of coagulopathy, non-survivors received more RBC (p=0.016), fibrinogen concentrate (p=0.01), and prothrombin complex concentrate (p<0.001) within 24 h of arrival in the emergency room. ROTEM testing appeared to offer an early signal of severe life-threatening sTBI. Further studies are warranted to confirm these results and to investigate the role of ROTEM in guiding coagulation therapy.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Vienna, Austria. herbert.schoechl@trauma.lbg.ac.at
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
authors.forename: Stefan
authors.initials: S
authors.lastname: Traintinger
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nienaber
authors.forename: Astrid
authors.initials: A
authors.lastname: Tacacs-Tolnai
authors.forename: Christian
authors.initials: C
authors.lastname: Windhofer
authors.forename: Soheyl
authors.initials: S
authors.lastname: Bahrami
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001772:Blood Cell Count; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology; D001780:Blood Coagulation Tests; D001784:Blood Gas Analysis; D001794:Blood Pressure / Q000502:physiology; D001930:Brain Injuries / Q000097:blood* / Q000150:complications; D003422:Critical Care; D004632:Emergency Medical Services; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D015600:Glasgow Coma Scale; D006487:Hemostasis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D019095:Point-of-Care Systems; D011379:Prognosis; D011517:Prothrombin Time; D017741:Survivors; D013916:Thrombelastography / Q000379:methods*; D055815:Young Adult
chemical_list: D005340:Fibrinogen