Blood coagulation test abnormalities in trauma patients detected by sonorheometry: a retrospective cohort study

Abstract

Background: Traumatic hemorrhage guidelines include point-of-care viscoelastic tests as a standard of care. Quantra (Hemosonics) is a device based on sonic estimation of elasticity via resonance (SEER) sonorheometry to assess whole blood clot formation.

Objectives: Our study aimed to assess the ability of an early SEER evaluation to detect blood coagulation test abnormalities in trauma patients.

Methods: We conducted an observational retrospective cohort study with data collected at hospital admission of consecutive multiple trauma patients from September 2020 to February 2022 at a regional level 1 trauma center. We performed a receiving operator characteristic curve analysis to determine the ability of the SEER device to detect blood coagulation test abnormalities. Four values on the SEER device were analyzed: clot formation time, clot stiffness (CS), platelet contribution to CS, and fibrinogen contribution to CS.

Results: A total of 156 trauma patients were analyzed. The clot formation time value predicted an activated partial thromboplastin time ratio of >1.5 with an area under the curve (AUC) of 0.93 (95% CI, 0.86-0.99). The AUC of the CS value in detecting an international normalized ratio of prothrombin time of >1.5 was 0.87 (95% CI, 0.79-0.95). The AUC of fibrinogen contribution to CS to detect a fibrinogen concentration of <1.5 g/L was 0.87 (95% CI, 0.80-0.94). The AUC of platelet contribution to CS to detect a platelet concentration of <50 G/L was 0.99 (95% CI, 0.99-1.00).

Conclusion: Our results suggest that the SEER device may be useful for the detection of blood coagulation test abnormalities at trauma admission.

Keywords: blood coagulation test; critical care; hemorrhage; multiple traumas; thromboelastography.

Figure 1

Flowchart of the study population. SEER, sonic estimation of elasticity via resonance.

Figure 2

Receiving operator characteristic curve analysis of the primary outcomes. (A) The curve represents the ability of clot time to detect an activated partial thromboplastin time (aPTT) >1.5 of the control. (B) The curve represents the ability of clot stiffness to detect an international normalized ratio (INR) of >1.5. (C) The curve represents the ability of fibrinogen contribution to clot stiffness to detect a fibrinogen concentration of ≤1.5 g/L. (D) The curve represents the ability of platelet contribution to clot stiffness to detect a platelet concentration of 50, 100, and 150 G/L or less. Analysis was based on 156 patients. AUC, area under the curve.

Figure 3

Results of correlation analysis. (A) Represents Pearson’s correlation coefficient between clot time (CT) and activated partial thromboplastin time (aPTT) ratio with control. (B) Represents Pearson’s correlation coefficient between clot stiffness (CS) and the international normalized ratio (INR). (C) Represents Pearson’s correlation coefficient between fibrinogen contribution to clot stiffness (FCS) and fibrinogen concentration obtained from the laboratory test. (D) Represents Pearson’s correlation coefficient between platelet contribution to clot stiffness (PCS) and platelet count obtained from the laboratory test. The analysis was based on 156 patients.