Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®
Abstract
:1. Introduction
2. Methods and Material
2.1. Material
- (1).
- Only patients admitted to a German hospital;
- (2).
- Standard documentation data record of TR-DGU;
- (3).
- Worst Abbreviated Injury Scale (AIS) ≥ 3;
- (4).
- Documentation of ROTEM use;
- (5).
- Primary Admission to a trauma centre (no interhospital transfer);
- (6).
- Patients with a risk of bleeding, defined as coagulopathy (PTT ≥ 40, or INR ≥ 1.4 or Quick’s value ≤ 60%) [27] or the need for blood transfusion before ICU admission;
- (7).
- Level I or II treating centre;
- (8).
- Regional or supra-regional hospitals with >10 trauma cases per year.
2.2. Methods
- -
- Hospital mortality;
- -
- Risk of death based on the Revised Injury Severity Classification score (RISC II) [28] This score was developed and validated with TR-DGU data and considers age, worst and second worst injury, head injury, pupils, Glasgow Coma Scale (GCS), age and sex, penetrating mechanism, blood pressure, base excess, haemoglobin and prehospital cardiac arrest;
- -
- Use of haemostatic therapy: PCC, antifibrinolytics, fibrinogen and tranexamic acid (TXA);
- -
- RBC transfusion: units of pRBC;
- -
- Probability of massive transfusion (Trauma Associated Severe Haemorrhage (TASH) [29] Score.
3. Results
3.1. Haemostatic Therapy
3.2. RBC Transfusion Rates
3.3. Mortality
4. Discussion
4.1. Haemostatic Therapy
4.1.1. Prothrombotic Agents
4.1.2. Antifibrinolytic Agents
4.1.3. RBC Transfusion Rates
4.2. Mortality
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
AIS | Abbreviated injury scale |
AUC | AUC—Akademie der Unfallchirurgie GmbH |
CCT | Conventional coagulation testing |
CPR | Cardiopulmonary resuscitation |
DGU | Deutsche Gesellschaft für Unfallchirurgie e. V. |
e.g., | Example given |
ER | Emergency room |
Et al. | Et alii |
FFP | Fresh frozen plasma |
GCS | Glasgow Coma Scale |
ICU | Intensive care unit |
INR | International normalised ratio |
MHP | Major Haemorrhage Protocols |
MT | Massive transfusion (>10 RBC/24 h) |
POC | Point of care |
PCC | Prothrombin concentrate |
(p)RBC | (Packed) red blood cells |
PT | Prothrombin time |
PTT | Partial thromboplastin time |
RISC II | Revised injury severity score, version 2 |
ROTEM® | Rotational thromboelastometry |
SD | Standard deviation |
TASH | Trauma-associated severe haemorrhage |
TBI | Traumatic brain injury |
TIC | Trauma induced coagulopathy |
TR-DGU | TraumaRegister DGU® |
TXA | Tranexamic acid |
VEM | Viscoelastic methods |
VHA | Viscoelastic Haemostatic Assays |
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ROTEM Years | Non-ROTEM Years | p-Value | |
---|---|---|---|
Total, n (%) | 1151 (20.3) | 5946 (79.7) | |
Male sex, n (%) | 1078 (71.4) | 4065 (68.7) | 0.045 |
GCS ≤ 8, n (%) | 609 (41.8) | 2470 (43.6) | 0.236 |
Blunt trauma, n (%) | 1375 (93.2) | 5417 (94.1) | 0.180 |
AIS Head ≥ 3, n (%) | 750 (49.5) | 3284 (55.2) | <0.001 |
AIS Thorax ≥ 3, n (%) | 923 (60.9) | 3414 (57.4) | 0.014 |
AIS Abdomen ≥ 3, n (%) | 366 (24.2) | 1377 (23.2) | 0.412 |
AIS Extremities ≥ 3, n (%) | 725 (47.9) | 2675 (45.0) | 0.046 |
SBP ≤ 90 mmHg, n (%) | 414 (29.9) | 1.439 (27.9) | 0.149 |
Intubated, n (%) | 953 (63.2) | 3728 (63.4) | 0.881 |
Resuscitated, n (%) | 132 (8.7) | 510 (8.7) | 0.918 |
MOF, n (%) | 645 (46.2) | 2871 (53.0) | <0.001 |
average PTT | 43.7 (30.1) | 44.0 (29.1) | 0.062 |
average INR | 1.74 (1.13) | 1.75 (1.17) | 0.929 |
average platelet count (in 1000) | 192 (84) | 189 (89) | 0.131 |
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Riehl, K.; Lefering, R.; Maegele, M.; Caspers, M.; Migliorini, F.; Schenker, H.; Hildebrand, F.; Fröhlich, M.; Driessen, A. Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®. J. Clin. Med. 2022, 11, 6150. https://doi.org/10.3390/jcm11206150
Riehl K, Lefering R, Maegele M, Caspers M, Migliorini F, Schenker H, Hildebrand F, Fröhlich M, Driessen A. Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®. Journal of Clinical Medicine. 2022; 11(20):6150. https://doi.org/10.3390/jcm11206150
Chicago/Turabian StyleRiehl, Katrin, Rolf Lefering, Marc Maegele, Michael Caspers, Filippo Migliorini, Hanno Schenker, Frank Hildebrand, Matthias Fröhlich, and Arne Driessen. 2022. "Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®" Journal of Clinical Medicine 11, no. 20: 6150. https://doi.org/10.3390/jcm11206150
APA StyleRiehl, K., Lefering, R., Maegele, M., Caspers, M., Migliorini, F., Schenker, H., Hildebrand, F., Fröhlich, M., & Driessen, A. (2022). Is ROTEM Diagnostic in Trauma Care Associated with Lower Mortality Rates in Bleeding Patients?—A Retrospective Analysis of 7461 Patients Derived from the TraumaRegister DGU®. Journal of Clinical Medicine, 11(20), 6150. https://doi.org/10.3390/jcm11206150