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Asim M, El-Menyar A, Peralta R, Arumugam S, Wahlen B, Ahmed K, Khan NA, Alansari AN, Mollazehi M, Ibnas M, Al-Hassani A, Parchani A, Chughtai T, Galwankar S, Al-Thani H, Rizoli S. Clinical Significance of Rotational Thromboelastometry (ROTEM) for Detection of Early Coagulopathy in Trauma Patients: A Retrospective Study. Diagnostics (Basel) 2025; 15:1148. [PMID: 40361963 PMCID: PMC12071595 DOI: 10.3390/diagnostics15091148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2025] [Revised: 04/18/2025] [Accepted: 04/27/2025] [Indexed: 05/15/2025] Open
Abstract
Background: We aimed to evaluate the clinical significance of abnormal rotational thromboelastometry (ROTEM) findings in trauma patients and investigate the relationships between FIBTEM-maximum clot firmness (MCF), fibrinogen concentration and patient outcomes. Methods: A retrospective cohort analysis was conducted on adult trauma patients who underwent on-admission ROTEM testing between January 2020 and January 2021. Univariate analyses compared data based on injury severity, ROTEM findings (normal vs. abnormal), and initial fibrinogen concentration (normal vs. hypofibrinogenemia). ROC curve analysis was performed to determine the diagnostic performance of FIBTEM A10/MCF for its association with hypofibrinogenemia. Results: A total of 1488 patients were included in this study; the mean age was 36.4 ± 14.2 years and 92% were male. In total, 376 (25.3%) patients had ROTEM abnormalities. Severe injuries (ISS ≥ 16) were associated with a higher shock index, positive troponin T levels, standard coagulation abnormalities, hypofibrinogenemia, and abnormal ROTEM parameters (p < 0.05). These patients also had higher rates of massive transfusions and in-hospital mortality (p = 0.001). Coagulation alterations were significantly associated with higher injury severity score (ISS), shock index, head abbreviated injury score (AIS), hypofibrinogenemia, transfusion need, and mortality (p < 0.05). Hypofibrinogenemic patients were younger, sustained severe injuries, had higher shock indices and coagulation marker levels, required more intensive treatments, had longer hospital stays, and had higher mortality (p < 0.05). A significant positive correlation was found between plasma fibrinogen concentration and FIBTEM-MCF (r = 0.294; p = 0.001). Conclusions: Approximately one-fourth of the patients had early traumatic coagulopathy, as assessed by ROTEM. The FIBTEM A10/MCF may serves as a surrogate marker for plasma fibrinogen concentration. While prior studies have established the link between ROTEM and injury severity, our findings reinforce its relevance across varying trauma severity levels. However, prospective studies are warranted to validate its role within diverse trauma systems and evolving resuscitation protocols.
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Affiliation(s)
- Mohammad Asim
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.A.); (N.A.K.); (M.I.)
| | - Ayman El-Menyar
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.A.); (N.A.K.); (M.I.)
- Clinical Medicine, Weill Cornell Medical College, Doha P.O. Box 3050, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
- Department of Surgery, Universidad Nacional Pedro Henriquez Urena, Santo Domingo P.O. Box 1423, Dominican Republic
| | - Suresh Arumugam
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Bianca Wahlen
- Department of Anesthesiology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Khalid Ahmed
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Naushad Ahmad Khan
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.A.); (N.A.K.); (M.I.)
| | - Amani N. Alansari
- Department of Pediatric Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Monira Mollazehi
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Muhamed Ibnas
- Clinical Research, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (M.A.); (N.A.K.); (M.I.)
| | - Ammar Al-Hassani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Ashok Parchani
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Talat Chughtai
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
| | - Sagar Galwankar
- Emergency Medicine Residency Program, College of Medicine, Sarasota Memorial Hospital, Florida State University, Sarasota, FL 34243, USA;
| | - Hassan Al-Thani
- Department of Surgery, Trauma and Vascular Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar;
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar; (R.P.); (S.A.); (K.A.); (M.M.); (A.A.-H.); (A.P.); (T.C.); (S.R.)
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