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Abstract

Introduction: Pelvic fractures are a complication of blunt force trauma and are frequently associated with multiple sites of injury. A majority of deaths occur in the first 48 hours as a result of massive hemorrhage into the pelvis, complicated by trauma-induced coagulopathy (TIC). Thromboelastographic (TEG)-guided blood component therapy (BCT) has been theorized to lower mortality and transfusion requirements in patients with TIC. Despite the high incidence of coagulopathy in patients with pelvic fractures, no case studies or guidelines exist for TEG use in these patients. Methods: In this study, we used TEG to guide BCT in 38 patients with pelvic fractures. Clinical data collected included: age, gender, injury mechanism, systolic blood pressure (SBP), calculated base deficit (BD), TEG® Platelet Mapping™ (TEG/PM) parameters, mortality, INR, PTT, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) not influenced by sedation upon admission in the ED. Results: In 30 of our 38 patients, adenosine diphosphate (ADP) and arachidonic acid (AA) inhibition of thrombus formation and strength were also evaluated by TEG/PM. We demonstrated significant statistical correlation between SBP, BD, maximal amplitude (MA), and massive transfusion (MT). We have also described statistical correlation between ISS, BD ≥ 8, MT, and survivorship. In our studied patient population, the MA predicted MT (MA 50.7 ± 2.2) versus non-MT (MA 59.9 ± 1.5). No correlation was shown between the other TEG parameters. The ratio of BCT administered was 2/2/1 (packed red cells, platelets, and fresh frozen plasma). Conclusions: We have concluded that TEG provides point of care bedside goal-directed BCT for patients with pelvic fractures. Our data support the published criteria that the MA predicts those patients who require MT. TEG/PM also provides guidance for platelet administration.