Utility of interim ROTEM® values of clot strength, A5 and A10, in predicting final assessment of coagulation status in severely injured battle patients

Abstract

BackgroundProactive management of trauma-related coagulopathy requires early identification and rapid assessment in order to allow targeted resuscitation. This study determined whether early (interim) ROTEM® (TEM International GmbH, Munich, Germany) values could predict hypocoagulopathy in seriously injured military patients. MethodsNormal ranges for ROTEM® values were obtained from 50 volunteers. 108 samples were collected during the early phase of clinical management from 48 severe trauma patients. The blood was subject to EXTEM analysis and compared to the 95% tolerance limits from the volunteers. Coagulopathy (was deemed to be present if EXTEM MCF was below 40mm, which is in the range indicating clinical concern defined by the ROTEM® Expert Working Group. ResultsThe normal range data was broadly similar to ROTEM® published data. Admission samples were available from 31 battlefield casualties, and 39% of these were coagulopathic 51% of the samples from all 48 patients were coagulopathic (EXTEM MCF<40mm) and interim EXTEM values of these at 5 and 10min (A5 and A10) predicted coagulopathy with sensitivities/specificities of 0.96/0.58 (A5) and 1.00/0.70 (A10).In addition, statistical comparison of clotting domains between normal volunteers and trauma patients suggests a difference in clot strengths due to a difference in platelet function rather than platelet number (mean 142×109l−1). ConclusionsThe A10 value of ROTEM® provides an early sensitive and specific assessment of coagulopathy after military trauma and may be of utility in guiding bespoke resuscitation. We found some speculative evidence that in major trauma platelet function is particularly affected.