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Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study. | LitMetric

Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study.

Trauma Surg Acute Care Open

Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, Utah, USA.

Published: March 2017

AI Article Synopsis

  • Acute coagulopathy of trauma can significantly increase mortality rates and the need for blood products, making effective treatment crucial in trauma care.
  • Researchers have hypothesized that coagulopathy can be detected when blood clots fail under a specific impact force, potentially leading to a simpler method for screening coagulopathy at the point of injury.
  • Their study shows that clots from coagulopathic blood (diluted with saline) break under stress more often than those from non-coagulopathic blood, suggesting that Impact Thromboelastometry (ITEM) could be a practical tool for early detection of trauma-induced coagulopathy.

Article Abstract

Background: Acute coagulopathy of trauma is associated with high mortality and extensive use of blood products. Hemostatic resuscitation, the early administration of blood products with higher ratios of procoagulant components, may improve trauma outcomes in select cases, but can also worsen outcome if inappropriately used. Evolving approaches to hemostatic resuscitation utilize viscoelastic tests to provide a more rational basis for choosing blood component therapy regimens, but these tests are logistically rigorous. We hypothesized that coagulopathy could be detected by the failure of blood clots to remain intact when subjected to a predefined impact force.

Methods: We aim to develop a point-of-injury test for coagulopathy. We created coagulopathic blood using an ex vivo normal saline (NS) dilution model and allowed blood of varying dilutions to clot, then examined the behavior of the clotted blood when subjected to a uniform gravitationally induced sheer force.

Results: Clots created from coagulopatic blood (diluted to ≤50% with NS) failed under gravitational challenge at a significantly higher rate than non-coagulopathic blood dilutions.

Discussion: Impact thromboelastometry (ITEM) represents a simple, logistically lean method for detecting dilutional coagulopathy that may facilitate detection of trauma-induced coagulopathy. ITEM may thus function as a point-of-injury or point-of-care screening test for the presence of coagulopathy.

Level Of Evidence: Diagnostic studies, Level IV.

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5877890PMC
http://dx.doi.org/10.1136/tsaco-2016-000049DOI Listing

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