BACKGROUND: Injury leads to dramatic disturbances in coagulation with increased risk of bleeding followed by a hypercoagulable state. A comprehensive assessment of these coagulation abnormalities can be measured and described by thrombelastography. The purpose of this study was to identify whether admission rapid-thrombelastography (r-TEG) could identify patients at risk of developing pulmonary embolism (PE) during their hospital stay. METHODS: Patients admitted between September 2009 to February 2011 who met criteria for our highest-level trauma activation and were transported directly from the scene were included in the study. PE defined as clinically suspected and computed tomography angiography confirmed PE. We evaluated r-TEG values with particular attention to the maximal amplitude (mA) parameter that is indicative of overall clot strength. Demographics, vital signs, injury severity, and r-TEG values were then evaluated. In addition to r-TEG values, gender and injury severity score (ISS) were chosen a priori for developing a multiple logistic regression model predicting development of PE. RESULTS: r-TEG was obtained on 2,070 consecutive trauma activations. Of these, 2.5% (53) developed PE, 97.5% (2,017) did not develop PE. Patients in the PE group were older (median age, 41 vs. 33 years, p = 0.012) and more likely to be white (69% vs. 54%, p = 0.036). None of the patients in the PE group sustained penetrating injury (0% vs. 25% in the no-PE group, p < 0.001). The PE group also had admission higher mA values (66 vs. 63, p = 0.050) and higher ISS (median, 31 vs. 19, p = 0.002). When controlling for gender, race, age, and ISS, elevated mA at admission was an independent predictor of PE with an odds ratio of 3.5 for mA > 65 and 5.8 for mA > 72. CONCLUSION: Admission r-TEG mA values can identify patients with an increased risk of in-hospital PE. Further studies are needed to determine whether alternative anticoagulation strategies should be used for these high-risk patients. LEVEL OF EVIDENCE: Prognostic study, level III.
BACKGROUND: Injury leads to dramatic disturbances in coagulation with increased risk of bleeding followed by a hypercoagulable state. A comprehensive assessment of these coagulation abnormalities can be measured and described by thrombelastography. The purpose of this study was to identify whether admission rapid-thrombelastography (r-TEG) could identify patients at risk of developing pulmonary embolism (PE) during their hospital stay. METHODS:Patients admitted between September 2009 to February 2011 who met criteria for our highest-level trauma activation and were transported directly from the scene were included in the study. PE defined as clinically suspected and computed tomography angiography confirmed PE. We evaluated r-TEG values with particular attention to the maximal amplitude (mA) parameter that is indicative of overall clot strength. Demographics, vital signs, injury severity, and r-TEG values were then evaluated. In addition to r-TEG values, gender and injury severity score (ISS) were chosen a priori for developing a multiple logistic regression model predicting development of PE. RESULTS: r-TEG was obtained on 2,070 consecutive trauma activations. Of these, 2.5% (53) developed PE, 97.5% (2,017) did not develop PE. Patients in the PE group were older (median age, 41 vs. 33 years, p = 0.012) and more likely to be white (69% vs. 54%, p = 0.036). None of the patients in the PE group sustained penetrating injury (0% vs. 25% in the no-PE group, p < 0.001). The PE group also had admission higher mA values (66 vs. 63, p = 0.050) and higher ISS (median, 31 vs. 19, p = 0.002). When controlling for gender, race, age, and ISS, elevated mA at admission was an independent predictor of PE with an odds ratio of 3.5 for mA > 65 and 5.8 for mA > 72. CONCLUSION: Admission r-TEG mA values can identify patients with an increased risk of in-hospital PE. Further studies are needed to determine whether alternative anticoagulation strategies should be used for these high-risk patients. LEVEL OF EVIDENCE: Prognostic study, level III.
Authors: Emily F Midura; Peter L Jernigan; Joshua W Kuethe; Lou Ann Friend; Rosalie Veile; Amy T Makley; Charles C Caldwell; Michael D Goodman Journal: J Surg Res Date: 2015-03-05 Impact factor: 2.192
Authors: Sarah C Christiaans; Amy L Duhachek-Stapelman; Robert T Russell; Steven J Lisco; Jeffrey D Kerby; Jean-François Pittet Journal: Shock Date: 2014-06 Impact factor: 3.454
Authors: Belinda H McCully; Christopher R Connelly; Kelly A Fair; John B Holcomb; Erin E Fox; Charles E Wade; Eileen M Bulger; Martin A Schreiber Journal: J Am Coll Surg Date: 2017-03-16 Impact factor: 6.113
Authors: Allie M Massaro; Sean Doerfler; Kelsey Nawalinski; Bernard Michel; Nicolette Driscoll; Connie Ju; Hiren Patel; Francis Quattrone; Suzanne Frangos; Eileen Maloney-Wilensky; Michael Sean Grady; Sherman C Stein; Scott E Kasner; Monisha A Kumar Journal: Neurocrit Care Date: 2015-02 Impact factor: 3.210
Authors: Michelle B Mulder; Kenneth G Proctor; Evan J Valle; Alan S Livingstone; Dao M Nguyen; Robert M Van Haren Journal: World J Surg Date: 2019-12 Impact factor: 3.352