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Admission Rapid Thrombelastography (r-TEG) Can Replace Conventional Coagulation Tests in the Emergency Department: Experience with 1974 Consecutive Trauma Patients
John B Holcomb, Kristin M Minei*, Michelle L Scerbo*, Charles E Wade*, Rosemary A Kozar, Brijesh S Gill*, Rondel Albarado*, Michelle K McNutt*, James J McCarthy*, Bryan A Cotton*
UT Health, Houston, TX

Objective: Injury and shock leads to alterations in conventional coagulation tests (CCTs). Recently, r-TEG has become recognized as a comprehensive assessment of coagulation abnormalities. We have previously shown admission r-TEG results are available faster than CCTs and predict PE’s. We hypothesized r-TEGs more reliably predicted component transfusion than CCTs.
Methods: Consecutive patients admitted between September 2009 and February 2011 who were our highest level trauma activations were included. All had admission r-TEG and CCTs. We correlated r-TEG values (ACT, alpha, mA, LY-30) with their corresponding CCTs (PT/PTT, INR, platelet count and fibrinogen) for transfusion requirements. Charges were calculated for each test. Demographics, vital signs, and injury severity were recorded.
Results: We studied 1974 major trauma activations, median ISS was 17(9-26), 28% were in shock, 28% were transfused and 6% died within 24 hours. Overall, r-TEG correlated with CCTs. When controlling for age, injury mechanism, w-RTS, base excess and Hgb: ACT predicted patients with substantial bleeding and RBC transfusion better than PT/PTT or INR (p = 0.03); alpha was superior to fibrinogen for predicting plasma transfusion (p < 0.001); mA was superior to platelet count for predicting platelet transfusion (p < 0.001) and LY-30 documented fibrinolysis. These correlations improved for transfused, shocked or head injured patients. The charge for r-TEG (\) was similar to five CCTs (\).
Conclusion: r-TEG was clinically superior to five CCTs, identifying patients with an increased risk of early RBC, plasma and platelet transfusions, as well as fibrinolysis. Admission conventional coagulation tests can be replaced with r-TEG.

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