Thromboelastography parameters versus classical coagulation profile in trauma patients: Retrospective study

Abstract

Background: Thrombelastography (TEG) assesses the viscoelastic properties of the whole blood and it is more comprehensive and capable to detect any coagulation abnormalities in comparison to classical coagulation tests (CCTs). On this ground, TEG can be more efficient in acute settings. Therefore, the primary aim was to compare TEG parameters of traumatic brain injury (TBI) versus non-TBI (NTBI) patients. The secondary aim was to identify TEG versus CCT parameters associated with outcome. Methods: A cross-sectional retrospective observational study of 142 patients admitted to a university-based, Level 1 trauma center. TEG and CCT were collected on admission. Institutional Review Board approval was obtained for this study. SAS was used for categorical data were analyzed using Chi-square or Fisher's exact test. A comparison of continuous variables between TBI and NTBI patients was performed using the independent-sample t-test. Results: In a total of 142 patients, 48 patients had TBI and 94 patients did not. Overall, mortality was 20.4% (45.8% TBI vs. 7.4% NTBI). There were no significant associations between TEG or CCT parameters and studied variables some of which are injury severity score, abbreviated injury scale, craniotomy/ectomy, type of brain injury, discharge status, and blood pressure. There was no difference between the TBI and NTBI groups regarding TEG or CCT parameters. Maximum amplitude (MA) was the only parameter (TEG or CCT) associated with need for transfusion of packed red blood cell (PRBC) (P = 0.0377). PRBC transfusion was given in 94% of patients with an MA <57.4. Platelet transfusion was given in 89% of patients who have MA < 58.1. Fresh-frozen plasma (FFP) transfusion was given in 80% of patients who have R ≥5.8. PRBC transfusion was given in 77% of 18 patients with α <62.9. Conclusions: TEG parameters are potentially useful as means to rapidly diagnose coagulopathy and predict transfusion in trauma patients. Independently, the presence of TBI does not cause a detectable coagulopathy. TEG analysis is more efficient than the classical parameters in detecting patients who will need PRBC and FFP transfusion.