RESUMO
Objective To explore the correlation and difference between thromboelastography (TEG) and conventional coagulation tests (CCTs) in critically ill patients of emergency department,so as to provide valuable information for TEG clinical application.Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed.The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance.ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT.Then comparisons of sensitivity of detecting abnormalities of clotting factors among R,PT and APTT were made.The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of oα and MA to reflect abnormal platelet count or fibrinogen concentration.The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status.The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients.The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P ＜ 0.05.Results (1) R correlated weakly with PT and APTT,MA correlated moderately with FIB and PLT;K and α angle correlated moderately with PLT and weakly with FIB.For the TEG parameter,there was no correlation between R and MA.R correlated moderately with K,α,and K correlated strongly with α angle,MA,and α correlated strongly with MA.(2) For detecting PT ＞ 15.1 s,the sensitivity of R (＞ 10 min) was 32％ (95％ CI:0.20-0.47) and specificity was 90％ (95％CI:0.84-0.94).For detecting APTT ＞41.8 s,the sensitivity of R (＞ 10 min) was 39％ (95％ CI:0.25-0.54) and specificity was 91％ (95 ％ CI:0.85-0.95).(3) There was a low sensitivity for MA and α to detect PLT count or FIB concentration abnormality.(4) TEG was able to detect a few abnormal blood coagulation which CCTs could not detect.(5) TEG-guided transfusion reduced plasma transfusion ratein trauma patients.Conclusions There is a moderate or even weak correlation between TEG and CCTs parameters,R has a low sensitivity to detect abnormal blood coagulation factor than PT,APTT.TEG is mainly able to reflect functional abnormality of PLT and FIB rather than to reflect their quantitative changes.TEG is able to detect a few abnormal blood coagulation which CCTs are not able to detect.The use of TEG can reduces plasma transfusion rate in trauma patients.TEG has certain advantages over CCTs but is not able to completely replace CCTs.Individual component change and overall blood coagulation status can be assessed in their combination,suggesting more helpful for clinical diagnosis and treatment.
RESUMO
Objective To explore the correlation and difference between thromboelastography (TEG) and conventional coagulation tests (CCTs) in critically ill patients of emergency department,so as to provide valuable information for TEG clinical application.Methods TEG and CCTs data of critically ill patients admitted from August 2015 to September 2016 in emergency department of Xijing Hospital were prospectively collected and retrospectively analyzed.The correlational analyses of analogue parameters of TEG and CCTs were carried out to investigate their clinical significance.ROC curve was used to explore the sensitivity and specificity of R for diagnosis of abnormal PT and APTT.Then comparisons of sensitivity of detecting abnormalities of clotting factors among R,PT and APTT were made.The changes of α and MA in patients with abnormal platelet count or fibrinogen concentration were respectively counted so as to evaluate the ability of oα and MA to reflect abnormal platelet count or fibrinogen concentration.The results of TEG and CCTs were comprehensively analyzed to find out the capability of TEG and CCTs in reflecting the overall blood coagulation status.The differece in blood transfusion rate was compared between TEG and CCTs in trauma patients.The chi-square test of matched fourfold table was used to test the significance and there was statistical significance when P ＜ 0.05.Results (1) R correlated weakly with PT and APTT,MA correlated moderately with FIB and PLT;K and α angle correlated moderately with PLT and weakly with FIB.For the TEG parameter,there was no correlation between R and MA.R correlated moderately with K,α,and K correlated strongly with α angle,MA,and α correlated strongly with MA.(2) For detecting PT ＞ 15.1 s,the sensitivity of R (＞ 10 min) was 32％ (95％ CI:0.20-0.47) and specificity was 90％ (95％CI:0.84-0.94).For detecting APTT ＞41.8 s,the sensitivity of R (＞ 10 min) was 39％ (95％ CI:0.25-0.54) and specificity was 91％ (95 ％ CI:0.85-0.95).(3) There was a low sensitivity for MA and α to detect PLT count or FIB concentration abnormality.(4) TEG was able to detect a few abnormal blood coagulation which CCTs could not detect.(5) TEG-guided transfusion reduced plasma transfusion ratein trauma patients.Conclusions There is a moderate or even weak correlation between TEG and CCTs parameters,R has a low sensitivity to detect abnormal blood coagulation factor than PT,APTT.TEG is mainly able to reflect functional abnormality of PLT and FIB rather than to reflect their quantitative changes.TEG is able to detect a few abnormal blood coagulation which CCTs are not able to detect.The use of TEG can reduces plasma transfusion rate in trauma patients.TEG has certain advantages over CCTs but is not able to completely replace CCTs.Individual component change and overall blood coagulation status can be assessed in their combination,suggesting more helpful for clinical diagnosis and treatment.
RESUMO
Acute traumatic coagulopathy (ATC) is one of coagulopathy induced by severe trauma in the early phase of trauma.It is always with high morbidity,mortality and multiple organ failure.Early diagnosis and treatment is the main content of trauma surgery in the department of emergency and the key to reduce mortality.Thrombelastography (TEG) can comprehensively assess the different stages of coagulation,early diagnose disturbance of blood coagulation and guide the goal-directed therapy with low complications,mortality and medical costs.TEG has been widely used in the operation of cardiac surgery,liver transplantation and trauma surgery to monitor coagulation and guide therapy.This paper mainly reviews the clinical value of thrombelastography in diagnosis and treatment of acute traumatic coagulopathy.