[Point-of-care diagnostics compared to standard coagulation tests in multiple trauma. Pros and cons].
The haemostasiological management of patients with multiple injuries requires rapid and adequate therapy decisions due to the highly dynamic surroundings. For this, diagnostic techniques which have the ability to detect and differentiate coagulation disorders that are commonly present in multiple trauma patients are necessary. Widely used routine coagulation tests (e.g., aPTT or PT) sensitively measure impairments of the intrinsic or extrinsic pathway, but without further identification or differentiation. Important influencing parameters like acidosis, hypothermia, fibrinolysis or polymerization dysfunction but especially the clot quality are not detectable. Moreover, the turn around times of these tests are about 30-60 min. However, thrombelastography measures clot strength and stability in whole blood under the present conditions of the injured patient. Impairments of clot quality can be differentiated. Because of the visualization of the clot formation, a patient's coagulation capacity can be assessed within minutes. Admittedly the use of these point-of-care devices in the operation theatre requires human and temporal resources.
Klinik für Anästhesiologie und Intensivmedizin, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland, johanning.kai@mh-hannover.de.
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D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D001780:Blood Coagulation Tests / Q000379:methods* / Q000592:standards*; D004632:Emergency Medical Services / Q000592:standards; D005858:Germany; D006405:Hematology / Q000592:standards*; D006801:Humans; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D019095:Point-of-Care Systems / Q000592:standards*; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity