University of Colorado-Denver, Aurora, CO.
Denver Health Medical Center, Denver, CO.
Surgery. 2018 Sep;164(3):489-493. doi: 10.1016/j.surg.2018.04.029. Epub 2018 Jun 12.
Several thrombelastography functional assays have been developed to guide transfusion in injured patients, but how this acceleration of thrombelastography affects its ability to predict massive transfusion is unknown. The objective of this study is to compare citrated native, citrated kaolin, and citrated rapid thromboelastographies for their prediction of massive transfusion after trauma. We hypothesized that citrated native thrombelastography best predicts massive transfusion.
Data were collected as part of a prospective study of trauma activation patients. All patients received citrated native, citrated kaolin, or citrated rapid thromboelastographies. Logistic regression was used to assess the predictive performance of different thrombelastography assays for massive transfusion.
Measurements for all three TEG activating systems was available for 343 patients; 57 (16.6%) required a massive transfusion. Compared to citrated rapid thromboelastographies, citrated kaolin thromboelastographies performed better for activated clotting time/rapid and citrated native thromboelastographies for maximum amplitude and angle. Yet, the 95% confidence intervals overlapped considerably, suggesting the citrated rapid thromboelastographies produced comparable results to the other assays for activated clotting time/reaction time, maximum amplitude, and angle.
There was substantial overlap in the performance of the different thrombelastography assays, suggesting citrated rapid thrombelastography is a quick and effective method to guide hemostatic resuscitation in trauma patients and does not perform inferiorly to the citrated native or citrated kaolin thrombelastography despite the addition of activation factors.
已经开发出几种血栓弹力描记术功能检测方法来指导受伤患者的输血，但这种血栓弹力描记术的加速如何影响其预测大量输血的能力尚不清楚。本研究的目的是比较枸橼酸钠原生、枸橼酸钠高岭土和枸橼酸钠快速血栓弹力描记术在预测创伤后大量输血方面的作用。我们假设枸橼酸钠原生血栓弹力描记术最能预测大量输血。
数据是作为创伤激活患者的前瞻性研究的一部分收集的。所有患者均接受枸橼酸钠原生、枸橼酸钠高岭土或枸橼酸钠快速血栓弹力描记术检测。使用逻辑回归评估不同血栓弹力描记术检测对大量输血的预测性能。
343 名患者可获得所有三种 TEG 激活系统的测量值；57 名（16.6%）需要大量输血。与枸橼酸钠快速血栓弹力描记术相比，枸橼酸钠高岭土血栓弹力描记术在激活凝血时间/快速和枸橼酸钠原生血栓弹力描记术在最大振幅和角度方面表现更好。然而，95%置信区间重叠很大，表明枸橼酸钠快速血栓弹力描记术在激活凝血时间/反应时间、最大振幅和角度方面与其他检测方法产生的结果相当。
不同血栓弹力描记术检测方法的性能存在很大重叠，表明枸橼酸钠快速血栓弹力描记术是一种快速有效的方法，可以指导创伤患者的止血复苏，尽管添加了激活因子，但与枸橼酸钠原生或枸橼酸钠高岭土血栓弹力描记术相比，其性能并不差。
