title: Utility of interim ROTEM(®) values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients.
abstract: BACKGROUND
  Proactive management of trauma-related coagulopathy requires early identification and rapid assessment in order to allow targeted resuscitation. This study determined whether early (interim) ROTEM(®) (TEM International GmbH, Munich, Germany) values could predict hypocoagulopathy in seriously injured military patients.
  
  
  METHODS
  Normal ranges for ROTEM(®) values were obtained from 50 volunteers. 108 samples were collected during the early phase of clinical management from 48 severe trauma patients. The blood was subject to EXTEM analysis and compared to the 95% tolerance limits from the volunteers. Coagulopathy (was deemed to be present if EXTEM MCF was below 40 mm, which is in the range indicating clinical concern defined by the ROTEM(®) Expert Working Group.
  
  
  RESULTS
  The normal range data was broadly similar to ROTEM(®) published data. Admission samples were available from 31 battlefield casualties, and 39% of these were coagulopathic 51% of the samples from all 48 patients were coagulopathic (EXTEM MCF<40 mm) and interim EXTEM values of these at 5 and 10 min (A5 and A10) predicted coagulopathy with sensitivities/specificities of 0.96/0.58 (A5) and 1.00/0.70 (A10). In addition, statistical comparison of clotting domains between normal volunteers and trauma patients suggests a difference in clot strengths due to a difference in platelet function rather than platelet number (mean 142 × 10(9)l(-1)).
  
  
  CONCLUSIONS
  The A10 value of ROTEM(®) provides an early sensitive and specific assessment of coagulopathy after military trauma and may be of utility in guiding bespoke resuscitation. We found some speculative evidence that in major trauma platelet function is particularly affected.
authors.affiliation: Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, ICT Building, Birmingham, Research Park, Vincent Drive, Birmingham B15 2SQ, United Kingdom. tomwoolley@me.com
authors.forename: T
authors.initials: T
authors.lastname: Woolley
authors.forename: M
authors.initials: M
authors.lastname: Midwinter
authors.forename: P
authors.initials: P
authors.lastname: Spencer
authors.forename: S
authors.initials: S
authors.lastname: Watts
authors.forename: C
authors.initials: C
authors.lastname: Doran
authors.forename: E
authors.initials: E
authors.lastname: Kirkman
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001753:Blast Injuries / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D001780:Blood Coagulation Tests / Q000295:instrumentation; D042241:Early Diagnosis; D005260:Female; D006487:Hemostasis; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010976:Platelet Count; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012151:Resuscitation / Q000379:methods*; D012680:Sensitivity and Specificity; D013048:Specimen Handling; D013916:Thrombelastography / Q000379:methods; D013997:Time Factors; D014914:Whole Blood Coagulation Time / Q000379:methods*