ROTEM's utility in guiding resuscitation of traumatic lower extremity fracture patients

Rotational thromboelastometry (ROTEM) is a method for real-time detection of clotting derangements allowing for targeted blood product resuscitation. We sought to determine if coagulopathy profiles differed based on fracture location (comparing pelvic versus tibia and femur fractures), if ROTEM profiles correlated between both total hospital and intensive care unit length of stay (LOS), and if ROTEM profiles correlated with patients undergoing an immediate definitive fixation versus an early damage control approach to care.

A retrospective cohort study was performed using data from a level 1 trauma registry database. ICD codes were used to isolate operative lower extremity fractures that had a ROTEM on admission. Two cohorts were created: (1) stratification by fracture location including pelvis, femur, and tibia (n = 498) and (2) stratification by fixation method including external fixation versus early definitive fixation (n = 154). The fracture location cohort assessed length of stay parameters while the fixation cohort assessed fixation approaches with ROTEM profiles.

The majority of fracture location patients with ROTEM APTEM and ROTEM EXTEM profiles were physiologically coagulable with all three fracture locations. Most patients with ROTEM INTEM profiles showed hypocoagulable derangements with femur (75.2%), tibia (68.1%), and pelvic fractures (68.8%). Fractures classified as ROTEM APTEM hypocoagulable indicated a longer hospital LOS (r = 0.282) and ICU LOS (r = 0.510). No correlation was found between coagulopathy profiles and fixation approaches.

ROTEM studies on fracture types showed little consensus on ROTEM profiles correlating to a specific fracture location. ROTEM profiles collected showed limited predictive ability of a patient's hospital and ICU LOS. Early definitive fixation versus external fixation did not correlate between specific ROTEM profiles. Overall, there did not appear to be utility in routine use of ROTEM in fracture patients and this should be limited to those with severe multisystem injuries.