Rotation thromboelastometry (ROTEM) enables improved outcomes in the pediatric trauma population

J Int Med Res. 2018 Dec;46(12):5195-5204. doi: 10.1177/0300060518794092. Epub 2018 Sep 10.

Abstract

Objective: We evaluated the role of rotation thromboelastometry (ROTEM) in managing acute traumatic coagulopathy in pediatric patients with trauma.

Methods: A retrospective cohort of pediatric patients with trauma from six institutes was studied during a 10-year period from 2007 to 2017. The associations between ROTEM-guided, goal-directed coagulation therapy and clinical outcomes were determined.

Results: Three hundred thirty-two pediatric patients (age < 15 years) who were treated with ROTEM-guided, goal-directed coagulation therapy were matched to 332 control pediatric patients with conventional plasmatic coagulation tests. The ROTEM protocol was associated with a significant reduction in the interval for admission to acute traumatic coagulopathy treatment, less plasma transfusions in the first 24 hours of admission, and a favorable coagulopathy recovery. Furthermore, the median number of total hospital days was significantly shorter for patients who had the ROTEM protocol than for control patients.

Conclusions: There are significant favorable outcomes, including rapid acute traumatic coagulopathy treatment and a lower 24-hour blood product requirement, following ROTEM-guided, goal-directed coagulation therapy among pediatric patients with blunt trauma.

Keywords: Rotation thromboelastometry (ROTEM); acute traumatic coagulopathy; blunt trauma; pediatric; plasma transfusion; prothrombin complex concentrate.

MeSH terms

  • Blood Coagulation
  • Blood Coagulation Disorders / diagnosis*
  • Blood Coagulation Disorders / etiology
  • Blood Coagulation Disorders / therapy*
  • Blood Transfusion*
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Prognosis
  • Retrospective Studies
  • Thrombelastography*
  • Wounds and Injuries / complications*