Hiwase Abhiram D, Ovenden Christopher D, Kaukas Lola M, Finnis Mark, Zhang Zeyu, O'Connor Stephanie, Foo Ngee, Reddi Benjamin, Wells Adam J, Ellis Daniel Y
Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
Department of Neurosurgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Emerg Med Australas. 2025 Feb;37(1):e14480. doi: 10.1111/1742-6723.14480. Epub 2024 Aug 19.
Coagulation assessment in traumatic brain injury (TBI) typically relies upon laboratory-based standard coagulation tests (SCTs), including the activated partial thromboplastin time (aPTT), INR and platelet count. Rotational thromboelastometry (ROTEM) sigma is an alternative point-of-care assay; however, its role in isolated TBI is under-evaluated. The present study aims to assess the prognostic utility of ROTEM sigma in isolated TBI.
ROTEM sigma analysis was performed during the initial evaluation of patients presenting to the Royal Adelaide Hospital between February 2022 and 2023 with radiographically demonstrated traumatic intracranial haemorrhage and GCS ≤14. Patients with concomitant severe extracranial injury, or who received blood products or antifibrinolytic therapy prior to sample collection were excluded.
Thirty-six patients had blood samples analysed with ROTEM, 25 of these patients were also evaluated with paired SCTs. Twenty-two per cent (8/36) of patients with isolated TBI had a hypocoaguable ROTEM profile, and this was associated with an increased incidence of head injury-related death (50% [4/8] vs 11% [3/28], P = 0.03). Median diagnostic turn-around-times were shorter for ROTEM parameters compared to SCT counterparts: EXTEM clotting time (CT) versus INR (20 vs 63 min, P < 0.01), and INTEM CT versus aPTT (21 vs 63 min, P < 0.01). EXTEM CT, FIBTEM CT and INR values had similar performance in predicting head injury-related death, area under the receiver operator curves were 0.8, 0.8 and 0.7, respectively.
ROTEM sigma expedites the detection of clinically significant coagulopathy in isolated TBI. EXTEM and FIBTEM CT values are more rapidly attainable than INR and comparable in predicting head injury-related death.
创伤性脑损伤（TBI）的凝血评估通常依赖于基于实验室的标准凝血试验（SCTs），包括活化部分凝血活酶时间（aPTT）、国际标准化比值（INR）和血小板计数。旋转血栓弹力图（ROTEM）σ值是一种床旁检测方法；然而，其在单纯性TBI中的作用尚未得到充分评估。本研究旨在评估ROTEM σ值在单纯性TBI中的预后价值。
对2022年2月至2023年期间在皇家阿德莱德医院就诊、经影像学证实有创伤性颅内出血且格拉斯哥昏迷评分（GCS）≤14的患者进行初始评估时，进行ROTEM σ值分析。排除伴有严重颅外损伤或在样本采集前接受过血液制品或抗纤溶治疗的患者。
36例患者的血样进行了ROTEM分析，其中25例患者还进行了配对SCTs评估。22%（8/36）的单纯性TBI患者具有低凝性ROTEM特征，这与颅脑损伤相关死亡的发生率增加有关（50%[4/8]对11%[3/28]，P = 0.03）。与SCT参数相比，ROTEM参数的中位诊断周转时间更短：EXTEM凝血时间（CT）与INR相比（20对63分钟，P < 0.01），INTEM CT与aPTT相比（21对63分钟，P < 0.01）。EXTEM CT、FIBTEM CT和INR值在预测颅脑损伤相关死亡方面具有相似的性能，受试者操作曲线下面积分别为0.8、0.8和0.7。
ROTEM σ值可加快对单纯性TBI中具有临床意义的凝血病的检测。EXTEM和FIBTEM CT值比INR更快速获得，且在预测颅脑损伤相关死亡方面相当。
