title: Fibrinogen in trauma, an evaluation of thrombelastography and rotational thromboelastometry fibrinogen assays.
abstract: BACKGROUND
  Identifying hypofibrinogenemia in trauma is important. The optimal method of fibrinogen determination is unknown. We therefore evaluated fibrinogen levels determined by two whole blood viscoelastic hemostatic assays, thrombelastography functional fibrinogen (FF) and rotational thromboelastometry FIBTEM in trauma patients and compared these with the plasma-based Clauss method.
  
  
  METHODS
  Prospective study of consecutive adult trauma patients admitted to a level I trauma center. Levels of fibrinogen were analyzed by Clauss, FF, and FIBTEM on arrival. These methods were compared, and we then investigated whether specific cutoffs of fibrinogen levels were indicative for an increased risk of receiving a transfusion within the initial 6 h.
  
  
  RESULTS
  A total of 182 patients with an Injury Severity Score of 17 (9-26) were enrolled. Functional fibrinogen maximum amplitude (FF MA) and FIBTEM maximum clot firmness (MCF) had identical correlation coefficients when compared with those of Clauss fibrinogen (both ρ = 0.64, P < 0.001), and FF MA and FIBTEM MCF correlated with each other (ρ = 0.71, P < 0.001). By logistic regression, the following cutoffs of fibrinogen levels were associated with increased odds of receiving a transfusion, red blood cell concentrates: Clauss <2.5 g/L, FF MA <14.9 mm, FIBTEM MCF <10 mm; fresh frozen plasma and platelets: Clauss <2.5 g/L, FF MA <16.9 mm, FIBTEM MCF <14 mm.
  
  
  CONCLUSIONS
  The viscoelastic hemostatic assays for determining fibrinogen levels, FIBTEM and FF, are both correlated with the Clauss fibrinogen level, and there are no differences in the strength of these correlations. In this study, specific fibrinogen levels at arrival to the emergency department were indicative, although not necessarily causal, of increased odds of receiving a transfusion.
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas. Electronic address: martin.as.meyer@gmail.com.
authors.forename: Martin A S
authors.initials: MAS
authors.lastname: Meyer
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Sisse R
authors.initials: SR
authors.lastname: Ostrowski
authors.affiliation: Trauma Centre, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Sørensen
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas.
authors.forename: Anna Sina P
authors.initials: ASP
authors.lastname: Meyer
authors.affiliation: Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.affiliation: Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Center for Translational Injury Research and Department of Surgery, The University of Texas Health Science Center, Houston, Texas.
authors.forename: Pär I
authors.initials: PI
authors.lastname: Johansson
authors.affiliation: Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, Copenhagen University Hospital, Denmark; Trauma Centre, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Denmark; Department of Anaesthesia, Rigshospitalet, Copenhagen University Hospital, Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Stensballe
mesh_terms: D000328:Adult; D001803:Blood Transfusion; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012044:Regression Analysis; D013916:Thrombelastography / Q000379:methods*; D014947:Wounds and Injuries / Q000097:blood* / Q000628:therapy
chemical_list: D005340:Fibrinogen
keywords: Bleeding; FF; FIBTEM; Fibrinogen; Hemostasis; Transfusion; Trauma