title: FIBTEM provides early prediction of massive transfusion in trauma.
abstract: BACKGROUND
  Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM®) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT.
  
  
  METHODS
  This retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, Austria, with an injury severity score ≥16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM® analyses (extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) tests) were performed. We divided patients into two groups: massive transfusion (MT, those who received ≥10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0 to 9 units).
  
  
  RESULTS
  Of 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, P < 0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (P < 0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0 to 3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83).
  
  
  CONCLUSIONS
  FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings.
authors.affiliation: Ludwig Boltzmann Institute for Experimental and Clinical Traumatology and AUVA Research Centre, Donaueschingenstraße 13, A-1200 Vienna, Austria. herbert.schoechl@trauma.lbg.ac.at
authors.forename: Herbert
authors.initials: H
authors.lastname: Schöchl
authors.forename: Bryan
authors.initials: B
authors.lastname: Cotton
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nienaber
authors.forename: Henrik
authors.initials: H
authors.lastname: Fischer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Voelckel
authors.forename: Cristina
authors.initials: C
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001780:Blood Coagulation Tests; D001803:Blood Transfusion; D017707:Erythrocyte Transfusion; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013916:Thrombelastography; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy
chemical_list: D005340:Fibrinogen
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