title: Rotational thrombolelastometry produces potentially clinical useful results within 10 min in bleeding emergency department patients: the DEUCE study.
abstract: OBJECTIVE
  For the first time in the Emergency Department (ED), to assess the use of rotational thromboelastometry (ROTEM) in patients presenting with all-cause haemodynamic shock, specifically (a) to establish whether a 5- min (A5) or a 10-min result (A10) is accurate compared with a final maximum clot firmness (MCF) result; (b) to compare time to A10 and formal laboratory coagulation result; (c) to assess whether bleeding ED trauma, gastrointestinal and aortic aneurysm patients are coagulopathic according to ROTEM; and (d) to compare ROTEM results with formal laboratory coagulation parameters.
  
  
  METHODS
  Patients presenting to the ED in haemodynamic shock were recruited. A citrated coagulation sample was taken and once a ROTEM researcher arrived in the ED, was subjected to ROTEM analysis.
  
  
  RESULTS
  Between 28 September 2010 and 31 August 2011, 40 patients were recruited (15 gastrointestinal bleeds, 20 major trauma cases and five ruptured abdominal aortic aneurysms). A10 and MCF correlated well (κ=0.98); A5 and MCF correlated less well (κ=0.91). The mean time to result (SD) was 57 (28) min for the formal laboratory coagulation result and 50 (45) min for the ROTEM A10 result (including delay to start of analysis). Seven patients were coagulopathic on ROTEM.
  
  
  CONCLUSIONS
  Eighteen percent of bleeding ED patients are coagulopathic using ROTEM including 25% of trauma patients. A 10-min ROTEM clot firmness (A10) is an excellent surrogate for MCF and allows a result to be obtained earlier than formal laboratory results and potentially within 10 min of the patient arriving in the ED.
authors.affiliation: Emergency Medicine Research Group Edinburgh EMeRGE, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh EH16 4SA, UK. mattreed1@hotmail.com
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Reed
authors.forename: Alastair F
authors.initials: AF
authors.lastname: Nimmo
authors.forename: Danny
authors.initials: D
authors.lastname: McGee
authors.forename: Lynn
authors.initials: L
authors.lastname: Manson
authors.forename: Alice E
authors.initials: AE
authors.lastname: Neffendorf
authors.forename: Linzi
authors.initials: L
authors.lastname: Moir
authors.forename: Lucienne S
authors.initials: LS
authors.lastname: Donaldson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D012769:Shock / Q000503:physiopathology / Q000628:therapy*; D013916:Thrombelastography / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult