Substitution of ROTEM FIBTEM A5 for A10 in trauma: an observational study building a case for more rapid analysis of coagulopathy
- Resource Type
- Authors
- Aashish Chalasani; Kerin Walters; Alexander Blayney; James Winearls; Debbie Ho; Erick Chan; Donald Alexander Campbell; James P. A. McCullough; Elizabeth Wake
- Source
- European Journal of Trauma and Emergency Surgery. 48:1077-1084
- Subject
- Resuscitation
medicine.medical_specialty
animal structures
Sports medicine
Intraclass correlation
Benzeneacetamides
Critical Care and Intensive Care Medicine
03 medical and health sciences
0302 clinical medicine
Coagulopathy
Humans
Medicine
Orthopedics and Sports Medicine
Piperidones
Retrospective Studies
030222 orthopedics
business.industry
Fibrinogen
030208 emergency & critical care medicine
Blood Coagulation Disorders
medicine.disease
Confidence interval
Thrombelastography
Thromboelastometry
Anesthesia
Emergency Medicine
Surgery
Observational study
business
Cohort study
- Language
- ISSN
- 1863-9941
1863-9933
BackgroundRotational thromboelastometry (ROTEM®) allows guided blood product resuscitation to correct trauma induced coagulopathy in bleeding trauma patients. FIBTEM amplitude at 10 minutes (A10) has been widely used to identify hypofibrinogenaemia; locally a threshold of < 11 mm has guided fibrinogen replacement. Amplitude at 5 minutes (A5) carries an inherent time advantage. The primary aim was to explore the relationship between FIBTEM A5 and A10 in a large cohort of trauma patients and subgroups. Secondary aim was to investigate the use of A5 as a surrogate for A10 within a fibrinogen-replacement algorithm.MethodsRetrospective observational cohort study of 1539 consecutive trauma patients at a Level 1 trauma centre in Australia who received ROTEM on arrival to hospital. Consistency of agreement between FIBTEM A5 and A10 was assessed by the intra-class correlation coefficient (ICC) and Bland-Altman plot. Sub-group analysis was performed for number of packed red blood cell transfusions and by International Trauma Severity Score (ISS). A new fibrinogen replacement threshold was developed for A5 using the A5 – A10 bias and clinically compared to the existing A10 threshold.ResultsFIBTEM A5 displayed excellent consistency of agreement with A10. ICC = 0.972 (95% confidence interval [CI] 0.969 – 0.974) in the whole cohort. This was maintained within the sub-group analyses. Bias of A5 to A10 was -1.49 (95% CI 1.43 -1.56) mm. 19.34% patients met the original local threshold of A10 < 11 mm; 19.28% patients met the new, bias-adjusted threshold of A5 < 10 mm.ConclusionsWe demonstrate that ROTEM FIBTEM A5 reliably predicts A10 within the trauma setting. Importantly, this strength of agreement is demonstrated within major haemorrhage patients and those with major trauma. This further validates use of the A5 result over A10 for more rapid interpretation of results in time-critical resuscitation of trauma patients. Early analysis suggests that a modification of -1 to the A10 threshold might be appropriate for use with the A5 value in trauma patients. Further work is required to analyse this prospectively.