Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study

Kjersti Baksaas-Aasen; Susan Van Dieren; Kirsten Balvers; Nicole P Juffermans; Pål A Næss; Claire Rourke; Simon Eaglestone; Sisse Ostrowski; Jakob Stensballe; Simon Stanworth; Marc Maegele; Carel Goslings; Pär I Johansson; Karim Brohi; Christine Gaarder; TACTIC/INTRN collaborators

doi:10.1097/SLA.0000000000002825

Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study

Kjersti Baksaas-Aasen, Susan Van Dieren, Kirsten Balvers, Nicole P Juffermans, Pål A Næss, Claire Rourke, Simon Eaglestone, Sisse Ostrowski, Jakob Stensballe, Simon Stanworth, Marc Maegele, Carel Goslings, Pär I Johansson, Karim Brohi, Christine Gaarder, TACTIC/INTRN collaborators

Department of Clinical Medicine

32 Citations (Scopus)

Abstract

Objective: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). Background: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. Methods: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x10⁹/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. Results: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30. Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. Conclusions: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma.

Original language	English
Journal	Annals of Surgery
ISSN	0003-4932
DOIs	https://doi.org/10.1097/SLA.0000000000002825
Publication status	Published - 1 Dec 2019

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Baksaas-Aasen, K., Van Dieren, S., Balvers, K., Juffermans, N. P., Næss, P. A., Rourke, C., Eaglestone, S., Ostrowski, S., Stensballe, J., Stanworth, S., Maegele, M., Goslings, C., Johansson, P. I., Brohi, K., Gaarder, C., & TACTIC/INTRN collaborators (2019). Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002825

Baksaas-Aasen, K, Van Dieren, S, Balvers, K, Juffermans, NP, Næss, PA, Rourke, C, Eaglestone, S, Ostrowski, S, Stensballe, J, Stanworth, S, Maegele, M, Goslings, C, Johansson, PI, Brohi, K, Gaarder, C & TACTIC/INTRN collaborators 2019, 'Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000002825

@article{ecbd8f1a9c9646b39c34f401fffb7d54,

title = "Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study",

abstract = "Objective: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). Background: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. Methods: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x109/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. Results: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30. Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. Conclusions: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma.",

author = "Kjersti Baksaas-Aasen and {Van Dieren}, Susan and Kirsten Balvers and Juffermans, {Nicole P} and N{\ae}ss, {P{\aa}l A} and Claire Rourke and Simon Eaglestone and Sisse Ostrowski and Jakob Stensballe and Simon Stanworth and Marc Maegele and Carel Goslings and Johansson, {P{\"a}r I} and Karim Brohi and Christine Gaarder and {TACTIC/INTRN collaborators}",

year = "2019",

month = dec,

day = "1",

doi = "10.1097/SLA.0000000000002825",

language = "English",

journal = "Advances in Surgery",

issn = "0003-4932",

publisher = "Lippincott Williams & Wilkins",

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TY - JOUR

T1 - Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage

T2 - A Prospective Observational Multicenter Study

AU - Baksaas-Aasen, Kjersti

AU - Van Dieren, Susan

AU - Balvers, Kirsten

AU - Juffermans, Nicole P

AU - Næss, Pål A

AU - Rourke, Claire

AU - Eaglestone, Simon

AU - Ostrowski, Sisse

AU - Stensballe, Jakob

AU - Stanworth, Simon

AU - Maegele, Marc

AU - Goslings, Carel

AU - Johansson, Pär I

AU - Brohi, Karim

AU - Gaarder, Christine

AU - TACTIC/INTRN collaborators

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Objective: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). Background: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. Methods: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x109/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. Results: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30. Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. Conclusions: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma.

AB - Objective: Developing pragmatic data-driven algorithms for management of trauma induced coagulopathy (TIC) during trauma hemorrhage for viscoelastic hemostatic assays (VHAs). Background: Admission data from conventional coagulation tests (CCT), rotational thrombelastometry (ROTEM) and thrombelastography (TEG) were collected prospectively at 6 European trauma centers during 2008 to 2013. Methods: To identify significant VHA parameters capable of detecting TIC (defined as INR > 1.2), hypofibrinogenemia (< 2.0 g/L), and thrombocytopenia (< 100 x109/L), univariate regression models were constructed. Area under the curve (AUC) was calculated, and threshold values for TEG and ROTEM parameters with 70% sensitivity were included in the algorithms. Results: A total of, 2287 adult trauma patients (ROTEM: 2019 and TEG: 968) were enrolled. FIBTEM clot amplitude at 5 minutes (CA5) had the largest AUC and 10 mm detected hypofibrinogenemia with 70% sensitivity. The corresponding value for functional fibrinogen (FF) TEG maximum amplitude (MA) was 19 mm. Thrombocytopenia was similarly detected using the calculated threshold EXTEM-FIBTEM CA5 30 mm. The corresponding rTEG-FF TEG MA was 46 mm. TIC was identified by EXTEM CA5 41 mm, rTEG MA 64 mm (80% sensitivity). For hyperfibrinolysis, we examined the relationship between viscoelastic lysis parameters and clinical outcomes, with resulting threshold values of 85% for EXTEM Li30 and 10% for rTEG Ly30. Based on these analyses, we constructed algorithms for ROTEM, TEG, and CCTs to be used in addition to ratio driven transfusion and tranexamic acid. Conclusions: We describe a systematic approach to define threshold parameters for ROTEM and TEG. These parameters were incorporated into algorithms to support data-driven adjustments of resuscitation with therapeutics, to optimize damage control resuscitation practice in trauma.

U2 - 10.1097/SLA.0000000000002825

DO - 10.1097/SLA.0000000000002825

M3 - Journal article

C2 - 29794847

SN - 0003-4932

JO - Advances in Surgery

JF - Advances in Surgery

ER -

Data-driven Development of ROTEM and TEG Algorithms for the Management of Trauma Hemorrhage: A Prospective Observational Multicenter Study

Abstract

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