Mize Brandi M, Reif Rebecca J, Spears Garrett L, Kalkwarf Kyle J, Jensen Hanna K, Cherney Steven M, Mears Simon C
College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Department of Health Policy and Management, Fay W. Boozman College of Public Health, Little Rock, AR, USA.
Arch Orthop Trauma Surg. 2025 Feb 25;145(1):170. doi: 10.1007/s00402-025-05773-4.
Rotational thromboelastometry (ROTEM) is a method for real-time detection of clotting derangements allowing for targeted blood product resuscitation. We sought to determine if coagulopathy profiles differed based on fracture location (comparing pelvic versus tibia and femur fractures), if ROTEM profiles correlated between both total hospital and intensive care unit length of stay (LOS), and if ROTEM profiles correlated with patients undergoing an immediate definitive fixation versus an early damage control approach to care.
A retrospective cohort study was performed using data from a level 1 trauma registry database. ICD codes were used to isolate operative lower extremity fractures that had a ROTEM on admission. Two cohorts were created: (1) stratification by fracture location including pelvis, femur, and tibia (n = 498) and (2) stratification by fixation method including external fixation versus early definitive fixation (n = 154). The fracture location cohort assessed length of stay parameters while the fixation cohort assessed fixation approaches with ROTEM profiles.
The majority of fracture location patients with ROTEM APTEM and ROTEM EXTEM profiles were physiologically coagulable with all three fracture locations. Most patients with ROTEM INTEM profiles showed hypocoagulable derangements with femur (75.2%), tibia (68.1%), and pelvic fractures (68.8%). Fractures classified as ROTEM APTEM hypocoagulable indicated a longer hospital LOS (r = 0.282) and ICU LOS (r = 0.510). No correlation was found between coagulopathy profiles and fixation approaches.
ROTEM studies on fracture types showed little consensus on ROTEM profiles correlating to a specific fracture location. ROTEM profiles collected showed limited predictive ability of a patient's hospital and ICU LOS. Early definitive fixation versus external fixation did not correlate between specific ROTEM profiles. Overall, there did not appear to be utility in routine use of ROTEM in fracture patients and this should be limited to those with severe multisystem injuries.
旋转血栓弹力图（ROTEM）是一种用于实时检测凝血紊乱的方法，可实现针对性的血液制品复苏。我们试图确定凝血异常情况是否因骨折部位而异（比较骨盆骨折与胫骨和股骨骨折），ROTEM情况与总住院时间和重症监护病房住院时间（LOS）之间是否相关，以及ROTEM情况与接受即刻确定性固定治疗的患者和早期损伤控制治疗方法的患者之间是否相关。
使用一级创伤登记数据库中的数据进行回顾性队列研究。国际疾病分类代码用于筛选入院时进行了ROTEM检测的手术性下肢骨折患者。创建了两个队列：（1）按骨折部位分层，包括骨盆、股骨和胫骨（n = 498）；（2）按固定方法分层，包括外固定与早期确定性固定（n = 154）。骨折部位队列评估住院时间参数，而固定队列评估采用ROTEM情况的固定方法。
大多数具有ROTEM APTEM和ROTEM EXTEM情况的骨折部位患者在生理上可凝血，所有三个骨折部位均如此。大多数具有ROTEM INTEM情况的患者表现为股骨骨折（75.2%）、胫骨骨折（68.1%）和骨盆骨折（68.8%）的低凝紊乱。分类为ROTEM APTEM低凝的骨折表明住院时间更长（r = 0.282）和重症监护病房住院时间更长（r = 0.510）。未发现凝血异常情况与固定方法之间存在相关性。
关于骨折类型的ROTEM研究表明，对于与特定骨折部位相关的ROTEM情况，几乎没有达成共识。收集到的ROTEM情况对患者住院和重症监护病房住院时间的预测能力有限。早期确定性固定与外固定在特定ROTEM情况之间没有相关性。总体而言，在骨折患者中常规使用ROTEM似乎没有实用价值，应仅限于那些有严重多系统损伤的患者。
