Skip to main content

Comparison of point-of-care thrombelastography versus conventional coagulation tests in the emergency department management of trauma

Introduction

To guide the administration of blood products, coagulation screening of trauma patients should be fast and accurate. Conventional coagulation tests (CCT) are frequently not useful in the initial assessment of multiply injured patients, due to the delay in availability of results. The purpose of this study is to determine whether Rapid thrombelastography (RapidTEG®) results in 15 minutes correlate with Kaolin TEG or CCT.

Methods

A 6-month prospective observational study of adult patients with suspected multiple injuries was conducted at a Level 1 trauma center of a university hospital. TEG, RapidTEG®, and CCT (INR, aPTT, TT, fibrinogen, platelet count) were performed within 10 minutes of the patient's arrival. Physicians blinded to TEG/RapidTEG® results made the decision to transfuse based on clinical evaluation and prior threshold (cut-off) values for CCT. Cut-off values for RapidTEG® were retrospectively assessed. Correlations between TEG and CCT and between TEG and RapidTEG® parameters were calculated, as well as sensitivity and specificity of CCT and RapidTEG® for any blood product transfused on day 1.

Results

Seventy-six predominantly blunt trauma (96%, n = 73) patients comprised the dataset. The mean ISS was 18. Only weak correlation existed between CCT and relevant TEG parameters (r = 0.097 to 0.615). Strong correlation exists between Kaolin TEG and RapidTEG® for K, MA, G and LY30 (r = 0.844 to 0.988). At the predetermined cut-off points for treatment in trauma, CCT demonstrated poor sensitivity. Cut-off points for RapidTEG® demonstrated good sensitivity and specificity: RapidTEG®: Rapid K (seconds) 1.2; 80.0%; 59.2%; 0.785 (cut-off; sensitivity; specificity; AUC), Rapid angle (°) 74.7; 84.0%, 56.9%; 0.765, Rapid MA (mm) 61.5; 72.0%; 71.4%; 0.745. CCT: TT (seconds) 15; 28.6%; 88.9%; 0.529, aPTT (seconds) 60; 4.8%; 97.8%; 0.735, INR 1.5; 19.0%; 96.0%; 0.730.

Conclusions

In this study of severely injured blunt trauma patients, RapidTEG® can be utilized in lieu of kaolin TEG to provide faster test results. Cut-off points for treatment can be determined with RapidTEG® to provide improved sensitivity and specificity compared with CCT with respect to blood product transfusion.

Author information

Affiliations

Authors

Corresponding author

Correspondence to V Jeger.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Jeger, V., Willi, S., Liu, T. et al. Comparison of point-of-care thrombelastography versus conventional coagulation tests in the emergency department management of trauma. Crit Care 15, P438 (2011). https://doi.org/10.1186/cc9858

Download citation

Keywords

  • Fibrinogen
  • Trauma Patient
  • Kaolin
  • Blood Product
  • Trauma Center