title: In Trauma, Conventional ROTEM and TEG Results Are Not Interchangeable But Are Similar in Clinical Applicability.
abstract: There is growing interest in viscoelastic hemostatic assays rotational thromboelastometry (ROTEM) and thromboelastography (TEG) for trauma. Despite shared features, it is unknown whether their results are interchangeable and whether one is clinically superior in predicting mortality, blood transfusion, and diagnosing early trauma coagulopathy.
  
  
  
  We conducted a prospective observational study comparing equivalent ROTEM and TEG parameters. Severely injured patients expected to receive massive transfusion were included. Assays were performed simultaneously on admission and repeated over subsequent 12 hours. International normalized ratio ≥1.2 or fibrinogen <1 g/L defined coagulopathy. TEG used kaolin as coagulation initiator and ROTEM used tissue factor (conventional). Spearman nonparametric analysis and Bland-Altman difference mean plot revealed parameter association. Logistic regression and receiver operating characteristic curves measured predictive values.
  
  
  
  33 patients (74 ROTEM, 74 TEG) were included; 79% were male, mean Injury Severity Score was 23.5 ± 14, admission international normalized ratio was 1.33 ± 0.4, and 63.4% received blood transfusions. Overall, parameter agreement fell outside acceptable limits, with weak or no association. Clinically, ROTEM maximum clot firmness and TEG maximum amplitude showed reasonable predictive accuracy for mortality, strong accuracy for any or massive blood transfusion, reasonable for plasma transfusion and similar poor predictive accuracy for diagnosing coagulopathy.
  
  
  
  ROTEM and TEG results are not interchangeable, arguably due to different coagulation triggers. Assays had similar clinical performance.
authors.affiliation: St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8.
authors.forename: Sandro
authors.initials: S
authors.lastname: Rizoli
authors.affiliation: St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8.
authors.forename: Arimie
authors.initials: A
authors.lastname: Min
authors.affiliation: Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada M4N 3M5.
authors.forename: Adic Perez
authors.initials: AP
authors.lastname: Sanchez
authors.affiliation: Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9.
authors.forename: Pang
authors.initials: P
authors.lastname: Shek
authors.affiliation: Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9.
authors.forename: Richard
authors.initials: R
authors.lastname: Grodecki
authors.affiliation: St. Michael's Hospital, 30 Bond Street, 3074 Donnelly Wing, Toronto, ON, Canada M5B 1W8.
authors.forename: Precilla
authors.initials: P
authors.lastname: Veigas
authors.affiliation: Toronto Research Centre, Defence Research and Development Canada, 1133 Sheppard Avenue West, Toronto, ON, Canada M3K 2C9.
authors.forename: Henry T
authors.initials: HT
authors.lastname: Peng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D001803:Blood Transfusion / Q000145:classification; D019411:Clinical Laboratory Techniques / Q000379:methods / Q000592:standards; D005260:Female; D006489:Hemostatic Techniques / Q000592:standards*; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011446:Prospective Studies; D013916:Thrombelastography / Q000379:methods*; D014947:Wounds and Injuries / Q000097:blood / Q000503:physiopathology*