A prospective evaluation of thromboelastometry (ROTEM) to identify acute traumatic coagulopathy and predict massive transfusion in military trauma patients in Afghanistan
Rattachement africain : it, gb, us. Niveau de preuve : code pays fourni par la source.
Le résumé fourni par la source
BACKGROUND: Hemorrhage is the leading cause of preventable trauma-related mortality and is frequently aggravated by acute traumatic coagulopathy (ATC). Viscoelastic tests such as rotational thromboelastometry (ROTEM) may improve identification and management of ATC. This study aimed to prospectively evaluate changes in ROTEM among combat casualties during the first 24 hours and compare the capabilities of our conventional clotting assay (international normalized ratio [INR], >1.2) to a proposed integrated ROTEM model (INR >1.2 with the addition of tissue factor pathway activation thromboelastometry [EXTEM] A5 ≤35 mm and/or EXTEM LI30 <97% on admission) to identify ATC and predict massive transfusion (MT). STUDY DESIGN AND METHODS: This was a prospective observational study of trauma patients treated in NATO hospitals in Afghanistan between January 2012 and June 2013. ROTEM (EXTEM, functional fibrinogen thromboelastometry, APTEM, EXTEM with the addition of a fibrinolysis inhibitor) was performed on admission and at 6 and 24 hours by a designated research team. Treatment teams did not have access to the ROTEM results. RESULTS: ROTEM values were available for 40 male casualties. The integrated ROTEM model classified 15% more patients with ATC than with INR alone and increased the detection of those that required MT by 22%. The sensitivity of the integrated ROTEM model to predict MT was higher than with INR greater than 1.2 (86% vs. 64%); however, specificity with both definitions for predicting MT was poor (38% vs. 50%, respectively). CONCLUSION: These observations support the importance of early identification of and intervention in ATC. Integrating ROTEM into the definition of ATC would increase detection of those requiring MT arguing for its use as an adjunct to clinical presentation in the ultimate decision to initiate MT.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- A prospective evaluation of thromboelastometry (ROTEM) to identify acute traumatic coagulopathy and predict massive transfusion in military trauma patients in Afghanistan
- Date Crossref
- 01/04/2019
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Centro di Riferimento Oncologico pays non établi dans la noticeÉtablissement de santé
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University of Bristol pays non établi dans la noticeUniversité ou école supérieure
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Birmingham Research Park pays non établi dans la noticeInstitution
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United States Army Institute of Surgical Research pays non établi dans la noticeStructure de recherche
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Keesler Medical Center pays non établi dans la noticeÉtablissement de santé
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David Grant USAF Medical Center pays non établi dans la noticeÉtablissement de santé
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Maxwell Air Force Base pays non établi dans la noticeOrganisme public
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Cellex (United States) pays non établi dans la noticeEntreprise
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Joint Base San Antonio pays non établi dans la noticeOrganisme public
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Uniformed Services University of the Health Sciences Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Prisma Health pays non établi dans la noticeÉtablissement de santé
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East Carolina University pays non établi dans la noticeUniversité ou école supérieure
Centro di Riferimento Oncologico, University of Bristol et Birmingham Research Park, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.