Document Detail


Admission rapid thrombelastography predicts development of pulmonary embolism in trauma patients.
MedLine Citation:
PMID:  22695409     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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:
Bryan A Cotton; Kristin M Minei; Zayde A Radwan; Nena Matijevic; Evan Pivalizza; Jeanette Podbielski; Charles E Wade; Rosemary A Kozar; John B Holcomb
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  72     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-14     Completed Date:  2012-09-04     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1470-5; discussion 1475-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 by Lippincott Williams & Wilkins.
Affiliation:
Department of Surgery, The University of Texas Health Science Center, Houston, Texas 77030, USA. bryan.a.cotton@uth.tmc.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Distribution
Cohort Studies
Early Diagnosis
Female
Humans
Incidence
Injury Severity Score
Linear Models
Male
Middle Aged
Multivariate Analysis
Patient Admission
Predictive Value of Tests
Pulmonary Embolism / diagnosis*,  epidemiology*,  etiology
Retrospective Studies
Risk Assessment
Sex Distribution
Survival Rate
Thrombelastography / methods*
Time Factors
Trauma Centers
Wounds and Injuries / complications*,  diagnosis
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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