Correlation between laboratory coagulation testing and thromboelastometry is modified during management of trauma...

Area of Science:

• Trauma and Emergency Medicine
• Clinical Pathology
• Coagulation Science

Background:

• Thromboelastometry (ROTEM) is increasingly used for coagulopathy diagnosis and guiding hemostatic therapy (HT).
• Previous studies showed good correlation between ROTEM parameters and standard laboratory tests (SLT) before HT.
• The persistence of this correlation after hemostatic resuscitation remains unclear.

Purpose of the Study:

• To evaluate the correlation between ROTEM parameters and SLTs after hemostatic resuscitation in trauma patients.
• To assess if injury severity or blood product administration affects this correlation.
• To determine the diagnostic accuracy of ROTEM for coagulopathy during and after treatment.

Main Methods:

• Retrospective analysis of prospectively collected trauma registry data (2011-2014).
• ROTEM parameters (clotting time, clot amplitude) analyzed using EXTEM and FIBTEM assays.
• Spearman rank correlation calculated between SLTs and ROTEM; ROC curve analysis used for diagnostic thresholds.

Main Results:

• Correlation between INR and EXTEM-clotting time was good at admission (r=0.617) but decreased with lower Injury Severity Score or base excess.
• Post-resuscitation, correlation between INR and EXTEM-clotting time was impaired (r=0.430), particularly after fibrinogen concentrate (r=0.465 in severe injury).
• Diagnostic accuracy for elevated INR decreased significantly after fibrinogen concentrate administration; ROTEM accuracy for fibrinogen/platelet levels remained stable.

Conclusions:

• Correlation between SLTs and ROTEM parameters diminishes during and after hemostatic resuscitation.
• Factors like injury severity, base deficit, and blood product administration (especially fibrinogen) impact ROTEM-SLT correlation.
• Further research is required to identify the optimal tool for guiding hemostatic therapy in trauma patients.