Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV, 26506-9196, USA.
School of Medicine, West Virginia University, P.O. Box 9196, Morgantown, WV, 26506-9100, USA.
Eur J Trauma Emerg Surg. 2022 Feb;48(1):345-350. doi: 10.1007/s00068-020-01533-8. Epub 2020 Nov 11.
In patients with traumatic pelvic fractures, thromboelastography (TEG) is a useful tool to rapidly evaluate and identify coagulation disturbances. The purpose of this study was to examine the coagulation kinetics of patients with traumatic pelvic fractures (pelvic ring and/or acetabulum) by analyzing the TEG results at initial presentation and its relationship with mortality and blood loss.
A retrospective review at our Level-1 trauma center was conducted to identify Full Trauma Team activations (FTTa) with traumatic pelvic and/or acetabular fractures who were evaluated with a TEG on initial presentation between 2012 and 2016. In-hospital mortality, product transfusion, and hemoglobin changes were analyzed. Subgroup analysis was performed based on pelvic fracture type.
141 patients with a mean age of 49.0 ± 20.8 years and mean Injury Severity Score (ISS) of 25.18 ± 12.8 met inclusion criteria. PRBC transfusion occurred in 78.0% of patients; a total of 1486 blood products were transfused. A total of 65 patients (46.1%) underwent operative treatment for the pelvic injuries, and 18 patients (12.7%) required embolization. The overall in-hospital mortality rate was 14.9%. The degree of clot lysis at 30 min (LY30) was significantly associated with blood loss (p < 0.0001), units of packed red blood cells (PRBCs) transfused (p < 0.0001), and mortality rate (p = 0.0002).
Increased fibrinolysis evidenced by an elevated LY30 on initial TEG in patients with traumatic pelvic fractures is associated with increased blood loss, blood product transfusions, and mortality. Future studies should evaluate the clinical utility of reversing hyperfibrinolysis on initial TEG.
Prognostic level III.
在创伤性骨盆骨折患者中，血栓弹力图（TEG）是一种快速评估和识别凝血障碍的有用工具。本研究旨在通过分析初次就诊时的 TEG 结果，研究创伤性骨盆骨折（骨盆环和/或髋臼）患者的凝血动力学，并探讨其与死亡率和出血量的关系。
对我们的 1 级创伤中心进行回顾性研究，以确定在 2012 年至 2016 年间初次就诊时使用 TEG 评估的伴有创伤性骨盆和/或髋臼骨折的全面创伤团队激活（FTTa）患者。分析院内死亡率、血制品输注和血红蛋白变化。根据骨盆骨折类型进行亚组分析。
纳入了 141 名平均年龄为 49.0±20.8 岁，损伤严重程度评分（ISS）为 25.18±12.8 的患者。78.0%的患者输注了红细胞悬液；共输注了 1486 个血制品。共有 65 名（46.1%）患者接受了骨盆损伤的手术治疗，18 名（12.7%）患者需要栓塞治疗。总的院内死亡率为 14.9%。30 分钟时的血凝块溶解程度（LY30）与出血量（p<0.0001）、输注的红细胞单位数（p<0.0001）和死亡率（p=0.0002）显著相关。
在创伤性骨盆骨折患者中，初次 TEG 上出现的纤维蛋白溶解增加（表现为 LY30 升高）与出血量增加、血制品输注和死亡率升高有关。未来的研究应评估在初次 TEG 上逆转高纤维蛋白溶解的临床实用性。
预后 III 级。
