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Comparative Study
. 2012 Jun;72(6):1470-5; discussion 1475-7.
doi: 10.1097/TA.0b013e31824d56ad.

Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients

Bryan A Cotton  1 , Kristin M Minei, Zayde A Radwan, Nena Matijevic, Evan Pivalizza, Jeanette Podbielski, Charles E Wade, Rosemary A Kozar, John B Holcomb
Affiliations
Comparative Study

Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients

Bryan A Cotton et al. J Trauma Acute Care Surg. 2012 Jun.

Abstract

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.

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