title: Thromboelastography in Orthopaedic Trauma Acute Pelvic Fracture Resuscitation: A Descriptive Pilot Study.
abstract: OBJECTIVE
  To describe the adjunctive use of thromboelastography (TEG) in directing initial blood component therapy resuscitation of patients with polytrauma with acute pelvic/acetabular fractures.
  
  
  METHODS
  Retrospective cohort review.
  
  
  METHODS
  Level-2 trauma center.
  
  
  METHODS
  Forty adult trauma activations with acute pelvic and/or acetabular fractures were treated with standard fracture care and TEG with adjuvant platelet mapping (TEG/PM) analysis to guide their initial 24-hour resuscitation.
  
  
  METHODS
  TEG with PM provided goal-directed hemostatic resuscitation using component blood products and an established hospital transfusion protocol. Transfusions were triggered by abnormal TEG/PM results and/or the presence of active hemorrhage, persistent hemorrhagic shock, and abnormal base deficit levels.
  
  
  METHODS
  The correction of trauma-induced coagulopathy was determined by the return of a normal TEG/PM tracing. The numbers of component blood products transfused in the first 24 hours using TEG/PM were calculated. Subgroup analysis of transfusion requirements and differences between pelvic ring and acetabular fracture patterns were determined.
  
  
  RESULTS
  More than 90% of patients received a transfusion of at least 1 blood product with 84% of transfusions occurring within 6 hours of admission. TEG/PM-guided resuscitation yielded greater volumes of platelets and packed red blood cells (PRBCs) versus fresh frozen plasma (FFP) (P = 0.018) with an average transfusion ratio of 2.5:1:2.8 (PRBC:FFP:platelet). There was a trend toward greater transfusion requirements in combined injuries versus pelvic ring or acetabular fractures (P = 0.08).
  
  
  CONCLUSIONS
  TEG with PM is a valuable adjunct to guide the acute phase of resuscitation in patients with polytrauma with pelvic injuries because it allows a real-time assessment of the coagulation status. The routine use of TEG/PM may result in transfusion ratios of blood products different from those of the current empiric 1:1:1 guidelines.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Beacon Orthopaedic Trauma Surgery, South Bend, IN; †Memorial Hospital of South Bend, South Bend, IN; ‡Indiana University School of Medicine, South Bend, IN; §Self Regional Hospital, Greenwood, SC; ‖General and Vascular Surgery PC, South Bend, IN; and ¶W. M. Keck Center for Transgene Research, University of Notre Dame, Notre Dame, IN.
authors.forename: Christiaan N
authors.initials: CN
authors.lastname: Mamczak
authors.forename: Megan
authors.initials: M
authors.lastname: Maloney
authors.forename: Braxton
authors.initials: B
authors.lastname: Fritz
authors.forename: Bryan
authors.initials: B
authors.lastname: Boyer
authors.forename: Scott
authors.initials: S
authors.lastname: Thomas
authors.forename: Ed
authors.initials: E
authors.lastname: Evans
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Ploplis
authors.forename: Francis J
authors.initials: FJ
authors.lastname: Castellino
authors.forename: Jonathon
authors.initials: J
authors.lastname: McCollester
authors.forename: Mark
authors.initials: M
authors.lastname: Walsh
mesh_terms: D000077:Acetabulum / Q000293:injuries / Q000601:surgery; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016913:Blood Component Transfusion / Q000379:methods; D001803:Blood Transfusion / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D050723:Fractures, Bone / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy; D010384:Pelvic Bones / Q000293:injuries* / Q000601:surgery; D010865:Pilot Projects; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D013916:Thrombelastography / Q000379:methods*; D065227:Transfusion Reaction; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult