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Critical Care
Published in: Critical Care 6/2011

Open Access 01-12-2011 | Research

FIBTEM provides early prediction of massive transfusion in trauma

Authors: Herbert Schöchl, Bryan Cotton, Kenji Inaba, Ulrike Nienaber, Henrik Fischer, Wolfgang Voelckel, Cristina Solomon

Published in: Critical Care | Issue 6/2011

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Abstract

Introduction

Prediction of massive transfusion (MT) among trauma patients is difficult in the early phase of trauma management. Whole-blood thromboelastometry (ROTEM®) tests provide immediate information about the coagulation status of acute bleeding trauma patients. We investigated their value for early prediction of MT.

Methods

This retrospective study included patients admitted to the AUVA Trauma Centre, Salzburg, Austria, with an injury severity score ≥16, from whom blood samples were taken immediately upon admission to the emergency room (ER). ROTEM® analyses (extrinsically-activated test with tissue factor (EXTEM), intrinsically-activated test using ellagic acid (INTEM) and fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D (FIBTEM) tests) were performed. We divided patients into two groups: massive transfusion (MT, those who received ≥10 units red blood cell concentrate within 24 hours of admission) and non-MT (those who received 0 to 9 units).

Results

Of 323 patients included in this study (78.9% male; median age 44 years), 78 were included in the MT group and 245 in the non-MT group. The median injury severity score upon admission to the ER was significantly higher in the MT group than in the non-MT group (42 vs 27, P < 0.0001). EXTEM and INTEM clotting time and clot formation time were significantly prolonged and maximum clot firmness (MCF) was significantly lower in the MT group versus the non-MT group (P < 0.0001 for all comparisons). Of patients admitted with FIBTEM MCF 0 to 3 mm, 85% received MT. The best predictive values for MT were provided by hemoglobin and Quick value (area under receiver operating curve: 0.87 for both parameters). Similarly high predictive values were observed for FIBTEM MCF (0.84) and FIBTEM A10 (clot amplitude at 10 minutes; 0.83).

Conclusions

FIBTEM A10 and FIBTEM MCF provided similar predictive values for massive transfusion in trauma patients to the most predictive laboratory parameters. Prospective studies are needed to confirm these findings.
Appendix
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Metadata
Title
FIBTEM provides early prediction of massive transfusion in trauma
Authors
Herbert Schöchl
Bryan Cotton
Kenji Inaba
Ulrike Nienaber
Henrik Fischer
Wolfgang Voelckel
Cristina Solomon
Publication date
01-12-2011
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2011
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc10539

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