Evaluation of the Utility of Thromboelastography in a Tertiary Trauma Care Centre

Abstract

Background. Thromboelastography (TEG) unlike conventional coagulation assays evaluates the dynamic interaction of clotting factors and platelets indicating an overall clot quality. Literature assessing the efficacy of TEG in identifying trauma associated bleeding is lacking. Aim. To compare TEG with conventional plasma based coagulation tests and assess whether TEG can serve as a screening test or replace the conventional routine test. Materials. Retrospective data was collected for 150 severe trauma patients. Patients with known evidence of severe comorbidities, which may influence the outcome, were excluded. Detailed evaluation of the patient's clinical and laboratory records was conducted. Diagnostic characteristics such as sensitivity, specificity, and accuracy were calculated. Results. Fifty-one patients were defined as coagulopathic by the conventional coagulation test, 30 by the laboratory established range for TEG indices and 105 by manufactures range. Specificity and sensitivity for the laboratory established range for TEG were 29.4% and 84.8%; for manufactures range sensitivity was 74.5%, specificity was 32.3%. Conclusion. We observed that conventional coagulation assays are the most sensitive tests for diagnosis of coagulopathy due to trauma. However in emergency trauma situations, where immediate corrective measures need to be taken, coagulation parameters and conventional coagulation tests may cause delay. TEG can give highly specific results depicting the underlying coagulopathy.

The confusion continues: results from an American Association for the Surgery of Trauma survey on massive transfusion practices among United States trauma centers

“…Less than half of all institutions report point of care PT, INR, and PTT testing or TEG/ROTEM availability or incorporation into the MTP. Several studies have explored the use of TEG/ROTEM in trauma settings and have demonstrated its potential role in detecting early trauma‐induced coagulopathy, replacing conventional coagulation tests in the emergency setting, and guiding massive transfusion . The inability to use or incorporate TEG/ROTEM into the massive transfusion setting may represent a potential barrier to an institution's ability to transition to goal‐directed therapy when appropriate.…”

Faktor Risiko Hiperkoagulasi pada Thalassemia Anak

“…Dijumpai 70% hiperkoagulasi positif, tidak berbeda jauh dengan penelitian Lismayanti 3 (65,6%) hiperkoagulasi positif, tetapi tidak sejalan dengan penelitian Hastuti 23 hanya 5% subjek thalassemia dewasa yang mengalami hiperkoagulasi. Penelitian ini menggunakan TEG dengan 4 parameter, yaitu R-time, K-time, sudut alpha ( ), dan nilai MA seperti halnya penelitian Subramanian dkk 22 yang menyatakan bahwa kriteria hiperkoagulasi ditegakkan apabila terdapat minimal 2 atau lebih dari 4 parameter TEG. Penelitian Lismayanti 3 menggunakan 2 parameter, yaitu R-time dan K-time, sedangkan penelitian Hastuti 23 hanya menggunakan parameter CI saja.…”

“…Hiperkoagulasi dinilai dengan TEG, apabila ditemukan minimal 2 dari 4 parameter terpenuhi, yaitu R-time memendek, K-time memendek, sudut meningkat, besar Minimal Amplitudo (MA) meningkat, dengan atau tanpa nilai CI >3. 22 Derajat thalassemia terdiri atas derajat ringan, sedang, dan berat. 12 Tipe thalassemia terdiri atas thalassemia mayor dan intermedia.…”

Thromboelastography does not provide additional information to guide resuscitation in the severely injured

“…In recent years, indications for TEG have expanded to include assessing bleeding in trauma . Although viscoelastic assays have gained popularity in the last decade in trauma patients and several studies claim that TEG and rotational thromboelastometry are the most accurate tests for measuring coagulopathy in trauma patients and guiding haemostatic resuscitation, others have been more cautious . TEG also has some limitations.…”