Early thromboelastography in acute traumatic coagulopathy: an observational study focusing on pre-hospital trauma care

Background Major brain injury and uncontrolled blood loss remain the primary causes of early trauma-related mortality. One-quarter to one-third of trauma patients exhibit trauma-induced coagulopathy (TIC). Thromboelastometry (ROTEM) and thrombelastography (TEG) are valuable alternatives to standard coagulation testing, providing a more comprehensive overview of the coagulation process. Purpose Evaluating thromboelastographic profile, the incidence of fibrinolysis (defined as Ly30 > 3%) in severe trauma patients, and factors influencing pathological coagulation pattern. Methods Prospective observational 2 years cohort study on severe trauma patients assisted by Helicopter Emergency Medical System (HEMS) and Level 1 Trauma Center, in a tertiary referral University Hospital. Results Eighty three patients were enrolled, mean NISS (new injury severity score) 36 (+/- 13). MeanRvalue decreased from 7.25 (+/- 2.6) to 6.19 (+/- 2.5) min (p < 0.03); 48 (60%) patients had a reduction inRfromT(0)toT(1). In NISS 25-40 and NISS > 40 groups, changes inRvalue increased their significance (p = 0.04 andp < 0.03, respectively). Pathological TEG was found in 71 (88.8%) patients atT(0)and 74 (92.5%) atT(1). Hypercoagulation was present in 57 (71.3%) patients atT(0,)and in 66(82.5%) atT(1). 9 (11.3%) patients had hyperfibrinolysis atT(0), 7 (8.8%) patients atT(1). Prevalence of StO(2) < 75% atT(0)was greater in patients whose TEG worsened (7 patients, 46.7%) against whose TEG remained stable or improved (8 patients, 17.4%) fromT(0)toT(1)(p = 0.02). 48 (57.8%) patients received < 1000 mL of fluids, while 35 (42.2%) received >= 1000 mL. The first group had fewer patients with hypercoagulation (20, 41.6%) than the second (6, 17.6%) atT(1)(p < 0.03). No differences were found for same TEG pattern atT(0), nor other TEG pattern. Conclusion Our population is representative of a non-hemorrhagic severe injury subgroup. Almost all of our trauma population had coagulation abnormalities immediately after the trauma; pro-coagulant changes were the most represented regardless of the severity of injury. NISS appears to affect onlyRparameter on TEG. Hyperfibrinolysis has been found in a low percentage of patients. Hypoperfusion parameters do not help to identify patients with ongoing coagulation impairment. Small volume resuscitation and mild hypotermia does not affect coagulation, at least in the early post-traumatic phase.