title: Thromboelastometry and organ failure in trauma patients: a prospective cohort study.
abstract: BACKGROUND
  Data on the incidence of a hypercoagulable state in trauma, as measured by thromboelastometry (ROTEM), is limited and the prognostic value of hypercoagulability after trauma on outcome is unclear. We aimed to determine the incidence of hypercoagulability after trauma, and to assess whether early hypercoagulability has prognostic value on the occurrence of multiple organ failure (MOF) and mortality.
  
  
  METHODS
  This was a prospective observational cohort study in trauma patients who met the highest trauma level team activation. Hypercoagulability was defined as a G value of ≥ 11.7 dynes/cm(2) and hypocoagulability as a G value of <5.0 dynes/cm(2). ROTEM was performed on admission and 24 hours later.
  
  
  RESULTS
  A total of 1,010 patients were enrolled and 948 patients were analyzed. Median age was 38 (interquartile range (IQR) 26 to 53), 77% were male and median injury severity score was 13 (IQR 8 to 25). On admission, 7% of the patients were hypercoagulable and 8% were hypocoagulable. Altogether, 10% of patients showed hypercoagulability within the first 24 hours of trauma. Hypocoagulability, but not hypercoagulability, was associated with higher sequential organ failure assessment scores, indicating more severe MOF. Mortality in patients with hypercoagulability was 0%, compared to 7% in normocoagulable and 24% in hypocoagulable patients (P <0.001). EXTEM CT, alpha and G were predictors for occurrence of MOF and mortality.
  
  
  CONCLUSIONS
  The incidence of a hypercoagulable state after trauma is 10% up to 24 hours after admission, which is broadly comparable to the rate of hypocoagulability. Further work in larger studies should define the clinical consequences of identifying hypercoagulability and a possible role for very early, targeted use of anticoagulants.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.c.muller@amc.uva.nl.
authors.forename: Marcella C A
authors.initials: MC
authors.lastname: Müller
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.balvers@amc.uva.nl.|Department of Surgery, Trauma Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. k.balvers@amc.uva.nl.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Balvers
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.m.binnekade@amc.uva.nl.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Binnekade
authors.affiliation: National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9BQ, UK. Nicola.Curry@ouh.nhs.uk.
authors.forename: Nicola
authors.initials: N
authors.lastname: Curry
authors.affiliation: National Health Service Blood and Transplant/Hematology, John Radcliffe Hospital, Headley Way, Oxford, OX3 9BQ, UK. Simon.stanworth@NHSBT.NHS.UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Stanworth
authors.affiliation: Department of Traumatology, Oslo University Hospital, Ullevaal, Nydalen, N-0424, Oslo, Norway. tinagaar@online.no.
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.affiliation: Department of Traumatology, Oslo University Hospital, Ullevaal, Nydalen, N-0424, Oslo, Norway. KKOLSTAD@ous-hf.no.
authors.forename: Knut M
authors.initials: KM
authors.lastname: Kolstadbraaten
authors.affiliation: Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, Turner Street, London, E1 2AD, UK. Claire.Rourke@bartshealth.nhs.uk.
authors.forename: Claire
authors.initials: C
authors.lastname: Rourke
authors.affiliation: Trauma Sciences, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University, Turner Street, London, E1 2AD, UK. karimbrohi@gmail.com.
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.affiliation: Department of Surgery, Trauma Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.c.goslings@amc.uva.nl.
authors.forename: J Carel
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. n.p.juffermans@amc.uva.nl.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D009104:Multiple Trauma / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*