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Thromboelastography is predictive of mortality, blood transfusions, and blood loss in patients with traumatic pelvic fractures: a retrospective cohort study

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

In patients with traumatic pelvic fractures, thromboelastography (TEG) is a useful tool to rapidly evaluate and identify coagulation disturbances. The purpose of this study was to examine the coagulation kinetics of patients with traumatic pelvic fractures (pelvic ring and/or acetabulum) by analyzing the TEG results at initial presentation and its relationship with mortality and blood loss.

Methods

A retrospective review at our Level-1 trauma center was conducted to identify Full Trauma Team activations (FTTa) with traumatic pelvic and/or acetabular fractures who were evaluated with a TEG on initial presentation between 2012 and 2016. In-hospital mortality, product transfusion, and hemoglobin changes were analyzed. Subgroup analysis was performed based on pelvic fracture type.

Results

141 patients with a mean age of 49.0 ± 20.8 years and mean Injury Severity Score (ISS) of 25.18 ± 12.8 met inclusion criteria. PRBC transfusion occurred in 78.0% of patients; a total of 1486 blood products were transfused. A total of 65 patients (46.1%) underwent operative treatment for the pelvic injuries, and 18 patients (12.7%) required embolization. The overall in-hospital mortality rate was 14.9%. The degree of clot lysis at 30 min (LY30) was significantly associated with blood loss (p < 0.0001), units of packed red blood cells (PRBCs) transfused (p < 0.0001), and mortality rate (p = 0.0002).

Conclusion

Increased fibrinolysis evidenced by an elevated LY30 on initial TEG in patients with traumatic pelvic fractures is associated with increased blood loss, blood product transfusions, and mortality. Future studies should evaluate the clinical utility of reversing hyperfibrinolysis on initial TEG.

Level of evidence

Prognostic level III.

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Acknowledgements

The authors would like to acknowledge the contribution of Tyler E. Calkins, MD, to data collection and processing for this study.

Funding

No funding was received in support of this work.

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Authors and Affiliations

  1. Department of Orthopaedics, West Virginia University, P.O. Box 9196, Morgantown, WV, 26506-9196, USA

    Phillip A. Bostian, Justin J. Ray, Michelle A. Bramer & Matthew J. Dietz

  2. School of Medicine, West Virginia University, P.O. Box 9196, Morgantown, WV, 26506-9100, USA

    Brock A. Karolcik

  3. Department of Surgery, Trauma and Surgical Critical Care, West Virginia University, P.O. Box 9238, Morgantown, WV, 26506-9238, USA

    Alison Wilson

Authors
  1. Phillip A. Bostian
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  2. Justin J. Ray
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  3. Brock A. Karolcik
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  4. Michelle A. Bramer
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  5. Alison Wilson
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  6. Matthew J. Dietz
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Contributions

PAB: Participated in study design, data collection, data analysis, and final manuscript preparation; JJR: Participated in study design, data collection, data analysis, and final manuscript preparation; BAK: Participated in study design, data collection, data analysis, and final manuscript preparation; MAB: Participated in study design, data analysis, and final manuscript preparation; AW: Participated in study design, and final manuscript preparation; MJD: Participated in study design, data collection, data analysis, and final manuscript preparation.

Corresponding author

Correspondence to Matthew J. Dietz.

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The authors report no conflicts of interest or competing interests.

Ethical approval

Institutional Review Board approval was granted for this retrospective review.

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Bostian, P.A., Ray, J.J., Karolcik, B.A. et al. Thromboelastography is predictive of mortality, blood transfusions, and blood loss in patients with traumatic pelvic fractures: a retrospective cohort study. Eur J Trauma Emerg Surg 48, 345–350 (2022). https://doi.org/10.1007/s00068-020-01533-8

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  • DOI: https://doi.org/10.1007/s00068-020-01533-8

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