Coagulopathy occurs very early in trauma especially in more severe victims. Unlike Thromboelastography (TEG), conventional coagulation test (PT/APTT/INR) only measures about 4% of total coagulation process. Using TEG, our study aims to explore the relationship between Acute Coagulopathy in Trauma (ACoT) with severity of injury. (using ISS score).
We conduct a prospective crosssectional study over 6 month period where eligible, acute (less than 2 hour) polytrauma patient was selected. TEG readings performed upon arrival was compared with different ISS score. RESULT Thirty-six patients were included where 8.3% (3/36) have an ACoT, defined as APTT > 35sec. However there was a statistically significant drop of MA (maximal amplitude) in high ISS group (42.9mm) compared to low ISS group (54.8mm). Other TEG parameters showed no statistical significant.
The prevalence of ACoT in our study is small (8.3%) compared to previous work. This may be due to small sample size or a different in the timeframe of the blood sampling of other studies, ranging from 12 hour to 72 hour from injury. Patients with reduced clot strength (maximal amplitude < 50mm) evaluated by TEG was associated with higher mortality in multiple studies conducted in emergency setting. For example, Nystrup et al showed means ISS of 27 in this subgroup of patients with a high mortality. Amy JP et al showed relationship between low MA and platelet dysfunction and ultimately, the need of transfusion. Although statistically not significant, the trend of prolong R, more acute alpha angle and longer K values indicates more generalized coagulation dysfunction. Therefore, individualized transfusion strategy involving TEG-goal-directed approach appears promising.