Conventional Coagulation Tests are a better predictor of mortality than Viscoelastic Haemostatic Assays in trauma patients with shock: a prospective observational study.

Abstract

Purpose: Conventional Coagulation Tests (CCTs) and Viscoelastic Haemostatic Assays (VHAs) are currently used in guiding trauma resuscitation. However, the role of these tests in predicting mortality is less known. This study aims to analyze both CCTs and VHAs in predicting mortality.

Methods: A prospective observational study was conducted on adult trauma patients who presented in shock. They underwent VHA using rotational thromboelastometry (ROTEM ^® delta viscoelastic system by Werfen) and CCTs. Univariable and multivariable regression analysis was done to compare the predictive power of mortality between CCTs and VHAs.

Results: Out of 8,765 trauma patients screened, 106 were included. Descriptive statistics showed a majority of blunt injuries with road traffic incidents as the predominant mechanism. The median Injury Severity Score (ISS) was 24 (IQR 14-34). Mortality rate at 24 h was 9.4% and overall 30-day mortality was 26% (n = 28). Univariable analysis showed that reduced clotting time had better survival (p = 0.005) while prolonged INR, reduced fibrinogen and elevated d-dimer levels were associated with mortality. In multivariable analysis, prolonged INR > 1.66 (AUC 0.74, OR 9.4, 95% CI 2.6-34.1) and prolonged clotting time > 384 s (AUC 0.67, OR 7.4, 95% CI 1.1-51.9) had best prediction of mortality. Overall, CCTs were better at predicting mortality than VHA.

Conclusion: CCTs, especially INR proved to be a more reliable predictor of mortality compared to VHAs in trauma patients. These findings suggest that CCTs offer better prognostic value, although integrating both testing modalities could potentially enhance overall assessment and management strategies in trauma care.