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VOLUME 12 , ISSUE 1 ( January-April, 2023 ) > List of Articles

ORIGINAL RESEARCH

The Other Side of the Coin: Using Rotational Thromboelastometry to Stop or Avoid Blood Transfusions in Trauma Patients

José G Parreira, Sandro Rizoli, Joao Rezende-Neto

Keywords : Blood transfusion, Coagulopathy, Diagnostics, Hemorrhage, Injury, Massive transfusion, Rotational thromboelastometry, Shock, Trauma, Viscoelastic

Citation Information : Parreira JG, Rizoli S, Rezende-Neto J. The Other Side of the Coin: Using Rotational Thromboelastometry to Stop or Avoid Blood Transfusions in Trauma Patients. Panam J Trauma Crit Care Emerg Surg 2023; 12 (1):35-41.

DOI: 10.5005/jp-journals-10030-1413

License: CC BY-NC 4.0

Published Online: 29-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: To assess rotational thromboelastometry (ROTEM) as a tool to stop or avoid unnecessary transfusions in trauma patients. Materials and methods: Retrospective analysis in a period of 12 months, including all adult patients with a ROTEM assay upon arrival. In an initial analysis, patients were assigned to one of the two groups—“normal (NL) ROTEM” or “abnormal ROTEM.” The “NL ROTEM” group had all ROTEM parameters within the normal range. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and odds ratio (OR) were calculated, which was repeated in subgroups of patients with ISS ≥ 16 and with systolic blood pressure (SBP) ≤90 mm Hg. In a second analysis, prediction models for the transfusion of each blood product were created by multivariate logistic regression, including all ROTEM parameters and the SBP on hospital admission. The prediction models were analyzed by the area under the receiver operating characteristics curve (AUROC). Results: A total of 793 patients fulfilled the inclusion criteria (80.2% blunt trauma and 73.5% male). NL ROTEM was observed in 604 (76.2%) patients. The NL ROTEM NPV for transfusion of any blood product (BBP), plasma (PLS), platelets (PLT), and >9 units of red blood cells (>9 RBC) were, respectively, 94.7, 98.3, 98.8, and 99.7%. Regarding patients with ISS ≥ 16, the NL ROTEM NPV for BBP, PLS, PLT, and >9 RBC were, respectively, 83.8, 92.5, 96.3, and 98.8%. In the subgroup of patients admitted with SBP ≤ 90 mm Hg, NL ROTEM predicted 93.3% of cases in which massive transfusion did not happen. Considering all patients, the AUC observed for the prediction model of >9 RBC was 0.982. Conclusion: Patients with an NL ROTEM assay at admission had a lower need for blood transfusions in the first 24 hours after trauma, even in subgroups sustaining severe injuries and hemodynamic instability. Clinical significance: The NL ROTEM seems to be a useful tool to avoid transfusions in trauma patients.

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