Diagnostic performance of thromboelastometry in trauma-induced coagulopathy: a comparison between two level I trauma centres using two different devices
Diagnostic performance of thromboelastometry in trauma-induced coagulopathy: a comparison between two level I trauma centres using two different devices
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DOI：
10.1007/s00068-019-01165-7
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发表时间：
2021-04-01
影响因子：
2.1
通讯作者：
David, Jean-Stephane
中科院分区：
文献类型：
--
作者：
Bouzat, Pierre;Guerin, Romain;David, Jean-Stephane
目的 基于 ROTEM(R) 的算法的实施需要可靠的阈值来反映凝血酶原时间 (PT) 比率 > 1.2 和/或纤维蛋白原浓度 < 1.5 g l(-1)。我们的目标是比较两个一级创伤中心的两种设备（ROTEM(R) Sigma 和 Delta，IL Werfen，慕尼黑，德国）的诊断性能，用于诊断创伤后凝血病。方法 我们对两个时期的两个登记处进行了回顾性分析：2014 年 9 月至 2015 年 12 月在里昂南大学创伤中心和 2016 年 4 月至 2018 年 1 月在格勒诺布尔阿尔卑斯山创伤中心。使用受试者工作特征 (ROC) 分析对每个设备的 EXTEM 和 FIBTEM 检测检测凝血障碍患者的准确性进行了测试。结果 在研究期间，格勒诺布尔队列中的 74 名创伤患者和里昂队列中的 75 名创伤患者在入院时进行了 ROTEM(R) 和标准凝血测试。 ROTEM(R) Sigma 和 Delta 用于诊断创伤后凝血障碍的 5 分钟 FIBTEM 振幅 (A5)、FIBTEM 最大凝块硬度、EXTEM 凝血时间 (CT) 和 EXTEM A5 的两条 ROC 曲线之间没有发现统计学显着差异。对于每个设备，FIBTEM A5 预测低纤维蛋白原浓度的最佳阈值是 7 mm。 ROTEM(R) Sigma 和 Delta 诊断 PT 比率 > 1.2 的 EXTEM CT 阈值分别为 78 秒和 74 秒。结论 这些结果表明，基于 ROTEM(R) 的算法可以从一个创伤中心转移到另一个创伤中心，而与环境和使用的 ROTEM(R) 设备无关。
Purpose The implementation of a ROTEM(R)-based algorithm requires reliable thresholds to mirror a prothrombin time (PT) ratio > 1.2 and/or a fibrinogen concentration < 1.5 g l(-1). Our goal was to compare the diagnostic performances of two devices (ROTEM(R) Sigma and Delta, IL Werfen, Munich, Germany) in two level-I trauma centres for the diagnostic of post-traumatic coagulopathy. Methods We conducted a retrospective analysis of two registries across two periods of time: from September 2014 to December 2015 in Lyon-Sud university trauma centre and from April 2016 to January 2018 in the Grenoble Alps Trauma Centre. Accuracies of EXTEM and FIBTEM assays to detect patients with coagulation disorders were tested for each device using receiver operating characteristic (ROC) analyses. Results Within the study period, 74 trauma patients in the Grenoble cohort and 75 trauma patients in the Lyon cohort had concomitant ROTEM(R) and standard coagulation testing on admission. No statistically significant difference was found between the two ROC curves for FIBTEM amplitude at 5 min (A5), FIBTEM maximum clot firmness, EXTEM clotting time (CT) and EXTEM A5 for ROTEM(R) Sigma and Delta to diagnose post-traumatic coagulation disorders. The best threshold for FIBTEM A5 to predict low fibrinogen concentration was 7 mm for each device. EXTEM CT thresholds to diagnose PT ratio > 1.2 were 78 s and 74 s for ROTEM(R) Sigma and Delta, respectively. Conclusions These results suggest that ROTEM(R)-based algorithms may be transposed from one trauma centre to another independently of the setting and the ROTEM(R) device in use.