Pierre Bouzat1,2,3, Romain Guerin4, Bastien Boussat5,6,7, Jérôme Nicolas8, Aline Lambert8, Jules Greze4, Marc Maegele9, Jean-Stéphane David8,10. 1. Department of Anaesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble University Hospital, 38000, Grenoble, France. PBouzat@chu-grenoble.fr. 2. Grenoble Alps University, 38000, Grenoble, France. PBouzat@chu-grenoble.fr. 3. Pôle d'Anesthésie-Réanimation, Hôpital Albert Michallon, BP 217, 38043, Grenoble, France. PBouzat@chu-grenoble.fr. 4. Department of Anaesthesiology and Intensive Care Medicine, Grenoble Alps Trauma Centre, Grenoble University Hospital, 38000, Grenoble, France. 5. Grenoble Alps University, 38000, Grenoble, France. 6. Quality of Care Unit, Grenoble University Hospital, 38000, Grenoble, France. 7. Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4N1, Canada. 8. Charles Mérieux-Lyon Sud School of Medicine, University Lyon 1, 69495, Oullins, France. 9. Department of Traumatology and Orthopaedic Surgery, Cologne-Merheim Medical Center, Institue for Research in Operative Medicine, University Witten-Herdecke, Cologne, Germany. 10. Department of Anaesthesiology and Critical Care Medicine, Lyon-Sud Hospital, Hospices Civils de Lyon, 69495, Pierre Bénite, France.
Abstract
PURPOSE: The implementation of a ROTEM®-based algorithm requires reliable thresholds to mirror a prothrombin time (PT) ratio > 1.2 and/or a fibrinogen concentration < 1.5 g l-1. Our goal was to compare the diagnostic performances of two devices (ROTEM® Sigma and Delta, IL Werfen, Munich, Germany) in two level-I trauma centres for the diagnostic of post-traumatic coagulopathy. METHODS: We conducted a retrospective analysis of two registries across two periods of time: from September 2014 to December 2015 in Lyon-Sud university trauma centre and from April 2016 to January 2018 in the Grenoble Alps Trauma Centre. Accuracies of EXTEM and FIBTEM assays to detect patients with coagulation disorders were tested for each device using receiver operating characteristic (ROC) analyses. RESULTS: Within the study period, 74 trauma patients in the Grenoble cohort and 75 trauma patients in the Lyon cohort had concomitant ROTEM® and standard coagulation testing on admission. No statistically significant difference was found between the two ROC curves for FIBTEM amplitude at 5 min (A5), FIBTEM maximum clot firmness, EXTEM clotting time (CT) and EXTEM A5 for ROTEM® Sigma and Delta to diagnose post-traumatic coagulation disorders. The best threshold for FIBTEM A5 to predict low fibrinogen concentration was 7 mm for each device. EXTEM CT thresholds to diagnose PT ratio > 1.2 were 78 s and 74 s for ROTEM® Sigma and Delta, respectively. CONCLUSIONS: These results suggest that ROTEM®-based algorithms may be transposed from one trauma centre to another independently of the setting and the ROTEM® device in use.
PURPOSE: The implementation of a ROTEM®-based algorithm requires reliable thresholds to mirror a prothrombin time (PT) ratio > 1.2 and/or a fibrinogen concentration < 1.5 g l-1. Our goal was to compare the diagnostic performances of two devices (ROTEM® Sigma and Delta, IL Werfen, Munich, Germany) in two level-I trauma centres for the diagnostic of post-traumatic coagulopathy. METHODS: We conducted a retrospective analysis of two registries across two periods of time: from September 2014 to December 2015 in Lyon-Sud university trauma centre and from April 2016 to January 2018 in the Grenoble Alps Trauma Centre. Accuracies of EXTEM and FIBTEM assays to detect patients with coagulation disorders were tested for each device using receiver operating characteristic (ROC) analyses. RESULTS: Within the study period, 74 traumapatients in the Grenoble cohort and 75 traumapatients in the Lyon cohort had concomitant ROTEM® and standard coagulation testing on admission. No statistically significant difference was found between the two ROC curves for FIBTEM amplitude at 5 min (A5), FIBTEM maximum clot firmness, EXTEM clotting time (CT) and EXTEM A5 for ROTEM® Sigma and Delta to diagnose post-traumatic coagulation disorders. The best threshold for FIBTEM A5 to predict low fibrinogen concentration was 7 mm for each device. EXTEM CT thresholds to diagnose PT ratio > 1.2 were 78 s and 74 s for ROTEM® Sigma and Delta, respectively. CONCLUSIONS: These results suggest that ROTEM®-based algorithms may be transposed from one trauma centre to another independently of the setting and the ROTEM® device in use.
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