375 Is the Use of Thromboelastography in the Acute Young Trauma Patient Associated With Outcome and the Type and Amount of Blood Products Received?

Abstract

Thromboelastography (TEG) point-of-care systems allow for analysis of the sum of platelet function, coagulation proteases and inhibitors, and the fibrinolytic system within 30 minutes. This allows a clinician to guide transfusion more precisely with an appropriate type of blood product. Literature supports that TEG-guided resuscitation had lower mortality compared to standardized 1:1:1 (red blood cells (RBC), fresh-frozen plasma (FFP), and platelets) massive transfusion protocol (MTP) in penetrating trauma patients, but data has been sparse in examining the young trauma patient. The objective was to assess if TEG use was associated with the type and amount of blood products used and to compare outcomes between those that did and did not have TEG measured. The correlations between TEG and other measures of coagulation including prothrombin time, and international normalized ratio was assessed. A cross-sectional chart review study was performed with patients up to 30 years old seen with active bleeding resulting from trauma in two level one trauma centers serving children and utilizing the Florida Trauma registry from January 1, 2010 to June 26, 2018. Patients who met the standard for MTP retrospectively, but had not been placed on the MTP were also included. TEG use was evaluated in these patients. Blood products assessed included packed RBC, FFP, platelets, and cryoprecipitate. Outcomes included survival to hospital discharge, requiring surgery within 24 hours of arrival, receiving tranexamic acid (TXA), and receiving MTP. 258 patients were included in the analysis. The mean age was 21 years (SD5), 79% were male, 112 (43%) had penetrating trauma and 225 (87%) had polytrauma. MTP was instituted in 176 (69%) patients and 88 (34%) patients who had TEG measured. The mean TEG values were alpha 59 (56-61), kinetics 3.4 (2.5-4.2), maximum amplitude 51.8 (49.5-54.0), R-value 5.1 (4.5-5.7), and clot lysis time 141 (31-252). There were significant correlations between PTT and alpha (r=-0.46; p<0.001), PTT and Kinetics (r=0.53; p<0.001), and PTT and maximum amplitude (r=0.449; p<0.001). There were also significant correlations between PT and alpha (r=-0.29; p=0.008), and PT and maximum amplitude (r= -0.27; p=0.013). There was no significant correlation between TEG measures and INR. The associations between measurement of TEG and amount and type of blood product are described in Table 1. There was no significant association between no TEG and TEG measurement and survival to hospital discharge 62% vs 64% respectively (p=0.787). However, receiving TEG use had significant associations with requiring surgery within 24 hours 45% vs 61% (p=0.018), receiving TXA 20% vs 59% (p<0.001), and with receiving MTP 62% vs 83% (p=0.001), respectively. Measurement of TEG was associated with patients receiving TXA, MTP and more blood products. Components of TEG correlated with PT and PTT levels. Although there was no association with survival to hospital discharge, patients having TEG measured were more likely to undergo surgery within the first 24 hours of hospital arrival.