Department of Traumatology, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands.
Ann Surg. 2019 Dec;270(6):1178-1185. doi: 10.1097/SLA.0000000000002825.
Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs).
Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013.
To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x10/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms.
A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30.Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid.
We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma.
为创伤性出血期间创伤诱导性凝血病（TIC）的管理开发实用的数据驱动算法，用于黏弹性止血检测（VHA）。
2008 年至 2013 年期间，在欧洲 6 家创伤中心前瞻性地收集了来自常规凝血检测（CCT）、旋转血栓弹性描记术（ROTEM）和血栓弹性图（TEG）的入院数据。
构建单变量回归模型，以识别能够检测 TIC（定义为 INR > 1.2）、低纤维蛋白原血症（<2.0g/L）和血小板减少症（<100×10/L）的 VHA 显著参数。计算曲线下面积（AUC），并纳入具有 70%敏感性的 TEG 和 ROTEM 参数的阈值值。
共纳入 2287 例成年创伤患者（ROTEM：2019 例和 TEG：968 例）。FIBTEM 5 分钟时的凝血酶原时间（CA5）具有最大 AUC，10mm 检测出低纤维蛋白原血症，敏感性为 70%。功能性纤维蛋白原（FF）TEG 最大振幅（MA）的相应值为 19mm。通过计算 EXTEM-FIBTEM CA5 30mm 的阈值同样可以检测到血小板减少症。rTEG-FF TEG MA 的相应值为 46mm。EXTEM CA5 41mm、rTEG MA 64mm（敏感性 80%）可识别 TIC。对于纤维蛋白溶解亢进，我们研究了黏弹性纤溶参数与临床结局之间的关系，EXTEM Li30 的阈值值为 85%，rTEG Ly30 的阈值值为 10%。基于这些分析，我们构建了 ROTEM、TEG 和 CCT 的算法，以便与比例驱动输血和氨甲环酸一起使用。
我们描述了一种系统方法来定义 ROTEM 和 TEG 的阈值参数。这些参数被纳入算法中，以支持使用治疗药物进行复苏的基于数据的调整，优化创伤性控制复苏实践。
