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Efficacy of Thromboelastography (TEG) in Predicting Acute Trauma-Induced Coagulopathy (ATIC) in Isolated Severe Traumatic Brain Injury (iSTBI)

  • Venencia Albert
  • Arulselvi Subramanian
  • Hara Prasad Pati
  • Deepak Agrawal
  • Sanjeev Kumar Bhoi
Original Article

Abstract

To evaluate the efficacy of point-of-care thromboelastography (TEG) to predict acute trauma-induced coagulopathy (ATIC) in isolated severe TBI (iSTBI). We conducted an observational diagnostic cohort. Patients for whom TEG was performed before blood transfusion were stratified by conventional coagulation tests (CCTs) on admission and classified as “ATIC” (prothrombin time ≥ 16.70 s; international normalized ratio ≥ 1.27; activated partial thromboplastin time ≥ 28.80 s) (n = 24) or “no ATIC” (n = 34). Univariate analysis to compare groups, receiver operating characteristic analysis to establish cut-off and diagnostic validation was done. Fifty-eight patients were included [32(25–45) years; 97% male; GCS 6.3 ± 1.5]. 41% developed ATIC. Compared to no-ATIC, ATIC group had significantly prolonged κ-time (4.6 vs. 2.5 min; p = 0.01) and shortened α-angle (40.2° vs. 56.3°; p = 0.03). A cut-off for κ-time ≥ 3.7 (AUC 0.68 95% CI 0.54–0.82, specificity 70%, sensitivity 63%) and α angle ≤ 48.0 (AUC 0.66, 95% CI 0.51–0.81, specificity 67%, sensitivity 67%) was established. The diagnostic accuracy of this cut-off for identifying ATIC, was 55.6% with sensitivity (81.8%) and specificity (14.3%). TEG may be a clinically sensitive test for identifying the underlying coagulopathy following TBI. However confirmation with CCTs is recommended.

Keywords

Thromboelastography Point-of-care systems Blood coagulation tests Traumatic Brain injuries 

Notes

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the All India Institute of Medical Sciences Ethics Committee [Ref. IESC/T-431/30.11.2012,OT-1/27.01.2016] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Indian Society of Hematology and Blood Transfusion 2018

Authors and Affiliations

  • Venencia Albert
    • 1
  • Arulselvi Subramanian
    • 1
  • Hara Prasad Pati
    • 2
  • Deepak Agrawal
    • 3
  • Sanjeev Kumar Bhoi
    • 4
  1. 1.Department of Laboratory MedicineJai Prakash Narayan Apex Trauma Center, AIIMSNew DelhiIndia
  2. 2.Department of HematologyAIIMSNew DelhiIndia
  3. 3.Department of NeurosurgeryJai Prakash Narayan Apex Trauma Center, AIIMSNew DelhiIndia
  4. 4.Department of Emergency MedicineJai Prakash Narayan Apex Trauma Center, AIIMSNew DelhiIndia

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