Early evaluation of acute traumatic coagulopathy by thrombelastography

Posttraumatic coagulopathy is a major cause of morbidity. This prospective study evaluated the thrombelastography (TEG) system and PlateletMapping (Haemoscope Corporation, Niles, Ill) values posttrauma, and it correlated those values with transfusions and fatalities. After institutional review board approval, assays were performed on 161 trauma patients. One citrated blood sample was collected onsite (OS), and 1 citrate and 1 heparinized sample were collected within 1 h of arrival to the emergency department (ED). Paired and unpaired t -testing was performed for nominal data with chi square testing for categorical values. Except for a slight increase in clot strength (maximal amplitude [MA]), there were no significant changes from OS to the ED. None of the TEG parameters were significantly different for the 22 patients who required transfusion. PlateletMapping showed lower platelet adenosine diphosphate (ADP) responsiveness in patients who needed transfusions (MA = 22.7 ± 17.1 vs MA = 35.7 ± 19.3, P = 0.004) and a correlation of fibrinogen P = 0.013). For the 14 fatalities, TEG reaction (R) time was 3703 ± 11,618 versus 270 ± 393 s ( P = P 15%) was observed in 3 patients in the ED with a 67% fatality rate ( P =