Comparison of conventional coagulation tests and ROTEM in identifying trauma‐induced coagulopathy for massive haemorrhage protocol activation

OBJECTIVES: Trauma-induced coagulopathy (TIC) can be fatal but preventable if recognised early. With emerging uses of rotational thromboelastometry (ROTEM) to guide transfusions in trauma, patient outcomes with TIC-defined by initial ROTEM and conventional coagulation tests (CCTs) during massive haemorrhage protocol (MHP) activations were evaluated at a primary trauma centre in British Columbia. METHODS: /L, and Clauss Fibrinogen <1.5 g/L, was assessed for its correlation with mortality. Modified Poisson regression was used to model 28-day mortality. RESULTS: Twenty-two of sixty-eight patients (32%) had abnormal ROTEM but normal CCTs. TIC defined by CCTs was associated with increased mortality [24 h: 5/13 (38%) vs. 5/55 (9%), p = 0.025; 28d: 8/13 (62%) vs. 11/55 (20%), p = 0.002]; compared to ROTEM, which was not [24 h: 7/35 (20%) vs. 3/33 (9%), p = 0.307; 28d: 11/35 (31%) vs. 9/33 (27%), p = 0.594], despite requiring significantly higher blood component transfusion within the first 4 and 24 h of MHP (p-values<0.05). CONCLUSIONS: ROTEM is more sensitive in identifying TIC. Patients with abnormal CCTs had a higher death rate, and those with abnormal ROTEM had no significantly increased mortality. A prospective study is required to assess the effects of ROTEM further.