The impact of thromboelastography on patients with penetrating abdominal trauma requiring intensive care

Abstract

BackgroundTrauma induced coagulopathy is a complex multifaceted process which contributes to higher mortality rates in severely injured trauma patients. Thromboelastography (TEG) is an effective test to detect TIC which assists in instituting goal directed therapy as part of damage control resuscitation. MethodsThis retrospective study included all adult patients over a 36-month period with penetrating abdominal trauma who required a laparotomy, blood product transfusion and admission for critical care. Analysis included: demographics, admission data, 24-hour interventions, TEG parameters and 30-day outcomes. ResultsEighty-four patients with a median age of 28 years were included. The majority (93%) suffered from a gunshot injury with 75% receiving a damage control laparotomy. Forty-eight patients (57%) had a TEG. Injury Severity Score and total fluid & blood product administered in the first 24 hours were all significantly higher in patients that had a TEG (p<0.05). TEG profiles were: 42% normal, 42% hypocoagulable, 12% hypercoagulable and 4% mixed parameters.Fibrinolysis profiles were: 48% normal, 44% fibrinolysis shutdown and 8% hyperfibrinolysis.Mortality rate was 5% at 24 hours and 26% at 30 days, with no difference between the two groups. High grade complication rates, days on a ventilator and intensive care unit length of stay were all significantly higher in patients who did not have a TEG. 8 ConclusionTrauma induced coagulopathy is common in severely injured penetrating trauma patients. The usage of a thromboelastogram did not impact on 24-hour or 30-day mortality but did result in a decreased intensive care stay and a decreased high grade complication rate.