Prevalence and impact of abnormal ROTEM® assays in severe blunt trauma: results of the ‘Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study’

Background ROTEM ® /TEG ® (rotational thromboelastometry) assays appear to be useful for the treatment of bleeding trauma patients. However, data on the prevalence and impact of abnormal ROTEM ® assays are scarce. Methods This is a prospective cohort study of blunt trauma patients (Injury Severity Score ≥15 or Glasgow Coma Score ≤14) admitted to Innsbruck Medical University Hospital between July 2005 and July 2008. Standard coagulation tests, antithrombin (AT), prothrombin fragments (F1+2), thrombin–antithrombin complex (TAT), and ROTEM ® assays were measured after admission. Data on 334 patients remained for final analysis. Results ROTEM ® parameters correlated with standard coagulation tests (all Spearman r >0.5), and significant differences in mortality were detected for defined ROTEM ® thresholds [FIBTEM 7 mm (21% vs 9%, P =0.006), EXTEM MCF (maximum clot firmness) 45 mm (25.4% vs 9.4%, P =0.001)]. EXTEM MCF was independently associated with early mortality [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.9–0.99] and MCF FIBTEM with need for red blood cell transfusion (OR 0.92, 95% CI 0.87–0.98). In polytrauma patients with or without head injury ( n =274), the prevalence of low fibrinogen concentrations, impaired fibrin polymerization, and reduced clot firmness was 26%, 30%, and 22%, respectively, and thus higher than the prolonged international normalized ratio (14%). Hyperfibrinolysis increased fatality rates and occurred as frequently in isolated brain injury ( n =60) as in polytrauma ( n =274) (5%, 95% CI 1.04–13.92 vs 7.3%, 95% CI 4.52–11.05). All patients showed elevated F1+2 and TAT and low AT levels, indicating increased thrombin formation. Conclusions Our data enlarge the body of evidence showing that ROTEM ® assays are useful in trauma patients. Treatment concepts should focus on maintaining fibrin polymerization and treating hyperfibrinolysis.