Thromboelastometry in trauma care: a place in the 2018 Belgian health care system?

Introduction Evidence supporting the use of Thromboelastography (TEG®) and rotational thromboelastometric (ROTEM®) in the trauma setting remains limited. We present the results of a practical evaluation of the potential interest of ROTEM® in the diagnosis of acute coagulopathy and the need for emergent blood product transfusion in the general trauma population of a non-trauma Belgian emergency department. Methods Extracting a convenience cohort from the initial prospective TICCS study, we performed a retrospective analysis to test the following hypothesis: ROTEM® might be helpful to discriminate trauma patients with or without acute coagulopathy. Fifty patients were included and ROTEM® results were compared to conventional coagulation tests results, blood transfusion need and outcome. Results With a negative predictive value of 97.6% and a positive predictive value of 42.9%, a strictly normal ROTEM® profile at the time of admission seems to be able to exclude the presence of acute coagulopathy. ROTEM® also seems to be accurate in identifying patients without the need for emergent blood product transfusions. Conclusion In a population of trauma patients of a Belgian general emergency department, a strictly normal coagulation profile evaluated by ROTEM® at hospital entry is associated with a normal coagulation profile evaluated by INR and fibrinogen levels and the absence of any indication of blood product transfusion. ROTEM® may be useful for preselection of trauma patients at risk for coagulopathy within the global trauma population. This, however, would need confirmation in further investigations. TRIAL REGISTRATION: clinicaltrials.gov NCT02132208 Registered 6 May 2014.

Massive bleeding following severe blunt trauma: the first minutes that can change everything.

The first hour following a major trauma with massive bleeding is certainly the most decisive period in global trauma care. Most of it takes place during the prehospital care. Those prehospital minutes are thus determinant as they can be used to correctly identified patient's clinical condition, initiate organization of the in-hospital needed resources and initiate specific therapies in the very early phase after trauma. Significant recent advances in this aspect of care have been made and but evidence to support some of those strategies is still lacking.