Objective: To explore the value of thromboelastography (TEG) in patients with multiple trauma in emergency department.
Methods: The clinical data of 302 patients with multiple trauma hospitalized in the emergency department of Gansu Provincial People's Hospital from August 2015 to December 2018 were retrospectively analyzed. The general clinical data of the patients were collected. The patients were divided into three groups according to injury severity score (ISS): mild injury group (ISS ≤ 16), serious injury group (ISS 17-25), and severe injury group (ISS > 25). The results of vital signs, routine coagulation test, blood routine, blood biochemistry, and arterial blood gas analysis were recorded, and the National early warning score (NEWS) was calculated. TEG parameters were analyzed. Pearson correlation analysis and linear regression analysis were used to analyze the correlation between TEG indicators and NEWS score. Receiver operator characteristic (ROC) curve was plotted to analyze the diagnostic efficacy of TEG indicators for disseminated intravascular coagulation (DIC) in patients with severe injury.
Results: 299 patients were enrolled in the final analysis, including 92 patients in the mild injury group, 109 in the serious injury group and 98 in the severe injury group. With the increase in trauma severity, the NEWS score and TEG indicators including coagulation reaction time (R value) and blood clot generation time (K value) were gradually increased [NEWS score in mild, serious, and severe injury group was 3.46±0.89, 5.85±0.62, 9.75±1.76, R value (minutes) was 5.8±2.8, 7.8±2.6, 11.7±3.0, and K value (minutes) was 2.4±1.0, 4.2±1.4, 5.5±2.9, respectively], and blood clot generation rate (α angle), maximum width value (MA value) and coagulation index (CI) were gradually decreased [α angle (degree angle) in mild, serious, and severe injury group was 66.9±13.5, 55.7±22.9, 46.8±26.3, MA value (mm) was 51.8±9.7, 48.1±17.0, 38.5±15.2, and CI was 2.0±3.6, -2.8±3.5, -6.7±2.9, respectively], the differences were statistically significant among the groups (all P < 0.05). Pearson correlation analysis showed that the NEWS score was positively correlated with R and K values (r value was 0.463,0.588, respectively, both P < 0.01), and it was negatively correlated with α angle, MA value and CI (r value was -0.622, -0.689, -0.902, respectively, all P < 0.01). Linear correlation analysis showed that for every 1 minute increase in R value, NEWS score increased by 0.882 [95% confidence interval (95%CI) = 0.691 to 1.073]; for every 1 minute increase in K value, NEWS score increased by 0.484 (95%CI = 0.408 to 0.559); for every 1degree angleincrease in α angle, NEWS score decreased by 2.910 (95%CI = -3.325 to -2.494); for every 1 mm increase in MA value, NEWS score decreased by 2.223 (95%CI = -2.488 to -1.958); for every 1 increase in CI, NEWS score decreased by 1.292 (95%CI = -1.362 to -1.221). The R and K values in DIC patients (n = 37) of the severe injury group were significantly higher than those in non-DIC patients [n = 61; R value (minutes): 15.8±5.6 vs. 9.8±2.6, K value (minutes): 7.6±3.1 vs. 4.3±2.2], and α angle, MA value and CI were significantly lowered [α angle (degree angle): 48.7±19.8 vs. 59.6±26.2, MA value (mm): 37.5±19.2 vs. 49.2±18.6, CI: -8.5±3.4 vs. -5.2±3.1], the differences were statistically significant between the two groups (all P < 0.05). ROC curve analysis showed that the area under ROC curve (AUC) of the R and K values for predicting DIC was 0.999 and 0.958, respectively. When the optimal cut-off value of R value was 12.3 minutes, the sensitivity and specificity were 97.5% and 100%; when the optimal cut-off value of K value was 5.7 minutes, the sensitivity and specificity were 92.5% and 82.0%. The AUC of α angle, MA value and CI were 0.084, 0.060 and 0.114, which had no predictive value.
Conclusions: TEG indicators have clinical value on predicting the severity of illness in patients with multiple trauma. The changes in R and K values are effective indicators to judge the risk of DIC in patients with severe multiple trauma.