FIBTEM provides early prediction of massive transfusion in trauma.docVIP

FIBTEM provides early prediction of massive transfusion in trauma.doc

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FIBTEM provides early prediction of massive transfusion in trauma

Sch?chletal.CriticalCare2011,15:R265 /content/15/6/R265 RESEARCH OpenAccess FIBTEMprovidesearlypredictionofmassive transfusionintrauma HerbertSch?chl1,2*,BryanCotton3,KenjiInaba4,UlrikeNienaber5,HenrikFischer6,WolfgangVoelckel2and CristinaSolomon1,7 Abstract Introduction:Predictionofmassivetransfusion(MT)amongtraumapatientsisdifficultintheearlyphaseof traumamanagement.Whole-bloodthromboelastometry(ROTEM?)testsprovideimmediateinformationaboutthe coagulationstatusofacutebleedingtraumapatients.WeinvestigatedtheirvalueforearlypredictionofMT. Methods:ThisretrospectivestudyincludedpatientsadmittedtotheAUVATraumaCentre,Salzburg,Austria,with aninjuryseverityscore≥16,fromwhombloodsamplesweretakenimmediatelyuponadmissiontothe emergencyroom(ER).ROTEM? analyses(extrinsically-activatedtestwithtissuefactor(EXTEM),intrinsically-activated testusingellagicacid(INTEM)andfibrin-basedextrinsicallyactivatedtestwithtissuefactorandtheplatelet inhibitorcytochalasinD(FIBTEM)tests)wereperformed.Wedividedpatientsintotwogroups:massivetransfusion (MT,thosewhoreceived≥10unitsredbloodcellconcentratewithin24hoursofadmission)andnon-MT(those whoreceived0to9units). Results:Of323patientsincludedinthisstudy(78.9%male;medianage44years),78wereincludedintheMT groupand245inthenon-MTgroup.ThemedianinjuryseverityscoreuponadmissiontotheERwassignificantly higherintheMTgroupthaninthenon-MTgroup(42vs27,P0.0001).EXTEMandINTEMclottingtimeandclot formationtimeweresignificantlyprolongedandmaximumclotfirmness(MCF)wassignificantlylowerintheMT groupversusthenon-MTgroup(P0.0001forallcomparisons).OfpatientsadmittedwithFIBTEMMCF0to3 mm,85%receivedMT.ThebestpredictivevaluesforMTwereprovidedbyhemoglobinandQuickvalue(area underreceiveroperatingcurve:0.87forbothparameters).Similarlyhighpredictivevalueswereobservedfor FIBTEMMCF(0.84)andFIBTEMA10(clotamplitudeat10minutes;0.83). Conclusions:FIBTEMA10andFIBTEMMCFprovidedsimilarpredictivevaluesformassivetransfusionintrauma patientstothemostpredictivelaboratoryparameters.Prospec

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