Rapid TEG efficiently guides hemostatic resuscitation in trauma patients.

Abstract

Several thrombelastography functional assays have been developed to guide transfusion in injured patients, but how this acceleration of thrombelastography affects its ability to predict massive transfusion is unknown. The objective of this study is to compare citrated native, citrated kaolin, and citrated rapid thromboelastographies for their prediction of massive transfusion after trauma. We hypothesized that citrated native thrombelastography best predicts massive transfusion. Data were collected as part of a prospective study of trauma activation patients. All patients received citrated native, citrated kaolin, or citrated rapid thromboelastographies. Logistic regression was used to assess the predictive performance of different thrombelastography assays for massive transfusion. Measurements for all three TEG activating systems was available for 343 patients; 57 (16.6%) required a massive transfusion. Compared to citrated rapid thromboelastographies, citrated kaolin thromboelastographies performed better for activated clotting time/rapid and citrated native thromboelastographies for maximum amplitude and angle. Yet, the 95% confidence intervals overlapped considerably, suggesting the citrated rapid thromboelastographies produced comparable results to the other assays for activated clotting time/reaction time, maximum amplitude, and angle. There was substantial overlap in the performance of the different thrombelastography assays, suggesting citrated rapid thrombelastography is a quick and effective method to guide hemostatic resuscitation in trauma patients and does not perform inferiorly to the citrated native or citrated kaolin thrombelastography despite the addition of activation factors.