title: Changes in coagulation in standard laboratory tests and ROTEM in trauma patients between on-scene and arrival in the emergency department.
abstract: BACKGROUND
  When trauma patients arrive in the emergency department (ED), coagulopathy frequently is present. The time course, however, in which this coagulopathy develops is poorly understood. No study has fully evaluated the coagulation status, including thromboelastometry on-scene and at hospital arrival. We hypothesized that measured coagulation variables might change when measured at the scene of injury and upon arrival to the ED.
  
  
  METHODS
  We performed a prospective, single-center, observational study investigating coagulation status in 50 trauma patients on-scene and at arrival in the ED. Measurements included arterial blood gases, ROTEM®, protein S100, protein C activity, protein S, Quick value, international normalized ratio, activated partial thromboplastin time, D-dimer, coagulation factor V (FV), coagulation factor XIII (FXIII), fibrinogen, hemoglobin, hematocrit, platelets, and volume and blood products being administered during the first 24 hours.
  
  
  RESULTS
  Significant changes between on-scene and the ED were observed for the following values: partial venous oxygen pressure increased and sodium, glucose, and lactate decreased. For EXTEM, INTEM, and APTEM, clotting time and clot formation time increased significantly, whereas maximal clot firmness and angle α decreased significantly (all P ≤ 0.004). For FIBTEM, clotting time increased significantly and maximal clot firmness decreased significantly. In the laboratory, significant reductions in hemoglobin, hematocrit, platelets, activated partial thromboplastin time, fibrinogen, FV, FXIII, protein C activity, protein S, and protein S100 were observed (all P ≤ 0.001).
  
  
  CONCLUSIONS
  Although most all laboratory and rotational thromboelastometry coagulation tests worsened over time when measured on-scene and in the ED, monitoring coagulation at the scene of trauma does not provide clinically important information in a majority of trauma patients. One hour after injury, significant activation and consumption of fibrinogen, FV, FXIII, protein C activity, and protein S were observed.
authors.affiliation: From the Institute of Anesthesiology, University and University Hospital Zurich, Zurich, Switzerland; Division of Biostatistics, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland; and Schutz und Rettung Stadt Zürich, Zurich, Switzerland.
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Theusinger
authors.forename: Werner
authors.initials: W
authors.lastname: Baulig
authors.forename: Burkhardt
authors.initials: B
authors.lastname: Seifert
authors.forename: Stefan M
authors.initials: SM
authors.lastname: Müller
authors.forename: Sergio
authors.initials: S
authors.lastname: Mariotti
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D001784:Blood Gas Analysis; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013557:Switzerland; D013916:Thrombelastography; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D015415:Biomarkers