Thromboelastography is predictive of mortality, blood transfusions, and blood loss in patients with traumatic pelvic fractures: a retrospective cohort study.
Thromboelastography is predictive of mortality, blood transfusions, and blood loss in patients with traumatic pelvic fractures: a retrospective cohort study.
复制标题
DOI：
10.1007/s00068-020-01533-8
复制
发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Dietz MJ
中科院分区：
文献类型：
--
作者：
Bostian PA;Ray JJ;Karolcik BA;Bramer MA;Wilson A;Dietz MJ
在外伤性骨盆骨折患者中，血栓弹性成像（TEG）是快速评估和识别凝血障碍的有用工具。本研究的目的是通过分析初诊时的TEG结果及其与死亡率和失血的关系，研究外伤性骨盆骨折（骨盆环和/或髋臼）患者的凝血动力学。在我们的一级创伤中心进行了一项回顾性研究，以确定2012年至2016年期间首次出现创伤性骨盆和/或髋臼骨折时用TEG评估的完整创伤小组激活（FTTa）。分析住院死亡率、产品输血和血红蛋白变化。根据骨盆骨折类型进行亚组分析。141例患者符合纳入标准，平均年龄49.0±20.8岁，平均损伤严重程度评分（ISS）为25.18±12.8。78.0%的患者发生了PRBC输血；共输入1486份血液制品。65例（46.1%）患者接受手术治疗盆腔损伤，18例（12.7%）患者需要栓塞治疗。住院总死亡率为14.9%。30min凝块溶解程度（LY30）与失血量（p < 0.0001）、输血红细胞（红细胞）数量（p < 0.0001）和死亡率（p = 0.0002）显著相关。外伤性骨盆骨折患者初始TEG LY30升高证明纤维蛋白溶解增加与出血量、血制品输血和死亡率增加有关。未来的研究应该评估逆转高纤溶对初始TEG的临床应用。预后等级III。
In patients with traumatic pelvic fractures, thromboelastography (TEG) is a useful tool to rapidly evaluate and identify coagulation disturbances. The purpose of this study was to examine the coagulation kinetics of patients with traumatic pelvic fractures (pelvic ring and/or acetabulum) by analyzing the TEG results at initial presentation and its relationship with mortality and blood loss. A retrospective review at our Level-1 trauma center was conducted to identify Full Trauma Team activations (FTTa) with traumatic pelvic and/or acetabular fractures who were evaluated with a TEG on initial presentation between 2012 and 2016. In-hospital mortality, product transfusion, and hemoglobin changes were analyzed. Subgroup analysis was performed based on pelvic fracture type. 141 patients with a mean age of 49.0 ± 20.8 years and mean Injury Severity Score (ISS) of 25.18 ± 12.8 met inclusion criteria. PRBC transfusion occurred in 78.0% of patients; a total of 1486 blood products were transfused. A total of 65 patients (46.1%) underwent operative treatment for the pelvic injuries, and 18 patients (12.7%) required embolization. The overall in-hospital mortality rate was 14.9%. The degree of clot lysis at 30 min (LY30) was significantly associated with blood loss (p < 0.0001), units of packed red blood cells (PRBCs) transfused (p < 0.0001), and mortality rate (p = 0.0002). Increased fibrinolysis evidenced by an elevated LY30 on initial TEG in patients with traumatic pelvic fractures is associated with increased blood loss, blood product transfusions, and mortality. Future studies should evaluate the clinical utility of reversing hyperfibrinolysis on initial TEG. Prognostic level III.
登录
查看更多内容
DOI：
10.1186/1757-7241-20-15
发表时间：
2012-02-24
期刊：
Scandinavian journal of trauma, resuscitation and emergency medicine
影响因子：
--
作者：
Schöchl H;Maegele M;Solomon C;Görlinger K;Voelckel W
通讯作者：
Voelckel W
DOI：
10.1097/ta.0b013e318169cd3c
发表时间：
2008-05-01
影响因子：
--
作者：
Brohi, Karim;Cohen, Mitchell J.;Pittet, Jean-Francois
通讯作者：
Pittet, Jean-Francois
DOI：
10.1097/ta.0b013e318174e8bc
发表时间：
2008-06-01
影响因子：
--
作者：
Niles, Sarah E.;McLaughlin, Daniel F.;Holcomb, John B.
通讯作者：
Holcomb, John B.
影响因子：
5.2
作者：
Demetriades, D;Karaiskakis, M;Chan, L
通讯作者：
Chan, L
DOI：
10.1097/00005373-199709000-00001
发表时间：
1997-09-01
影响因子：
--
作者：
Agolini, SF;Shah, K;Reed, JF
通讯作者：
Reed, JF