title: Goal-directed transfusion protocol via thrombelastography in patients with abdominal trauma: a retrospective study.
abstract: BACKGROUND
  The optimal transfusion protocol remains unknown in the trauma setting. This retrospective cohort study aimed to determine if goal-directed transfusion protocol based on standard thrombelastography (TEG) is feasible and beneficial in patients with abdominal trauma.
  
  
  METHODS
  Sixty adult patients with abdominal trauma who received 2 or more units of red blood cell transfusion within 24 hours of admission were studied. Patients managed with goal-directed transfusion protocol via TEG (goal-directed group) were compared to patients admitted before utilization of the protocol (control group).
  
  
  RESULTS
  There were 29 patients in the goal-directed group and 31 in the control group. Baseline parameters were similar except for higher admission systolic blood pressure in the goal-directed group than the control group (121.8 ± 23.1 mmHg vs 102.7 ± 26.5 mmHg, p < 0.01). At 24 h, patients in the goal-directed group had shorter aPTT compared to patients in the control group (39.2 ± 16.3 s vs 58.6 ± 36.6 s, p = 0.044). Administration of total blood products at 24 h appeared to be fewer in the goal-directed group than the control group (10.2 [7.0-43.1]U vs 14.8 [8.3-37.6]U, p = 0.28), but this was not statistically significant. Subgroup analysis including patients with ISS ≥16 showed that patients in the goal-directed group had significantly fewer consumption of total blood products than patients in the control group (7[6.1, 47.0]U vs 37.6[14.5, 89.9]U, p = 0.015). No differences were found in mortality at 28d, length of stay in intensive care unit and hospital between the two groups.
  
  
  CONCLUSIONS
  Goal-directed transfusion protocol via standard TEG was achievable in patients with abdominal trauma. The novel protocol, compared to conventional transfusion management, has the potential to decrease blood product utilization and prevent exacerbation of coagulation function.
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Jianyi
authors.initials: J
authors.lastname: Yin
authors.affiliation: Department of General Surgery, The Affiliated Jiangyin Hospital of Southeast University Medical College, Jiangyin, China.
authors.forename: Zhenguo
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Yousheng
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Danhua
authors.initials: D
authors.lastname: Yao
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Shaoyi
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Wenkui
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.affiliation: Department of Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
keywords: Abdominal trauma; Thrombelastography; Transfusion; Trauma-induced coagulopathy
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