Comparison of Rapid-, Kaolin-, and Native-TEG Parameters in Burn Patient Cohorts With Acute Burn-induced Coagulopathy and Abnormal Fibrinolytic Function
Author:
Keyloun John W12ORCID, Le Tuan D34ORCID, Moffatt Lauren T25, Orfeo Thomas6, McLawhorn Melissa M2ORCID, Bravo Maria-Cristina6, Tejiram Shawn1, Bravo Maria-Cristina, Brummel-Ziedins Kathleen E, Callcut Rachael A, Cohen Mitchell J, Freeman Kalev, Gautam Aarti, Hammamieh Rasha, Jett Marti, McLawhorn Melissa M, Moffatt Lauren T, Petzold Linda R, Pusateri Anthony E, Shupp Jeffrey W, Varner Jeffrey D, Shupp Jeffrey W127, Pusateri Anthony E89ORCID,
Affiliation:
1. The Burn Center, Department of Surgery, MedStar Washington Hospital Center , Washington, DC 20010 , USA 2. Firefighters’ Burn and Surgical Research Laboratory, MedStar Health Research Institute , Washington, DC 20010 , USA 3. Research Directorate, U.S. Army Institute of Surgical Research, JBSA Fort Sam Houston , TX 78234 , USA 4. Department of Epidemiology and Biostatistics, University of Texas Tyler School of Medicine , Tyler, TX 75708 , USA 5. Department of Biochemistry, Georgetown University , Washington, DC 20057 , USA 6. Department of Biochemistry, College of Medicine, University of Vermont , Colchester, VT 05405 , USA 7. Department of Surgery, Georgetown University , Washington, DC 20057 , USA 8. Combat Casualty Care and Operational Medicine Directorate, Naval Medical Research Unit San Antonio, JBSA Fort Sam Houston , TX 78234 , USA 9. Department of Surgery, Uniformed Services University of Health Sciences , Bethesda, MD 20814 , USA
Abstract
Abstract
Although use of thromboelastography (TEG) to diagnose coagulopathy and guide clinical decision-making is increasing, relative performance of different TEG methods has not been well-defined. Rapid-TEG (rTEG), kaolin-TEG (kTEG), and native-TEG (nTEG) were performed on blood samples from burn patients presenting to a regional center from admission to 21 days. Patients were categorized by burn severity, mortality, and fibrinolytic phenotypes (Shutdown [SD], Physiologic [PHYS], and Hyperfibrinolytic [HF]). Manufacturer ranges and published TEG cutoffs were examined. Concordance correlations (Rc) of TEG parameters (R, α-angle, maximum amplitude [MA], LY30) measured agreement and Cohen’s Kappa (κ) determined interclass reliability. Patients (n = 121) were mostly male (n = 84; 69.4%), with median age 40 years, median TBSA burn 13%, and mortality 17% (n = 21). Severe burns (≥40% TBSA) were associated with lower admission α-angle for rTEG (P = .03) and lower MA for rTEG (P = .02) and kTEG (P = .01). MA was lower in patients who died (nTEG, P = .04; kTEG, P = .02; rTEG, P = .003). Admission HF was associated with increased mortality (OR, 10.45; 95% CI, 2.54–43.31, P = .001) on rTEG only. Delayed SD was associated with mortality using rTEG and nTEG (OR 9.46; 95% CI, 1.96–45.73; P = .005 and OR, 6.91; 95% CI, 1.35–35.48; P = .02). Admission TEGs showed poor agreement on R-time (Rc, 0.00–0.56) and α-angle (0.40 to 0.55), and moderate agreement on MA (0.67–0.81) and LY30 (0.72–0.93). Interclass reliability was lowest for R-time (κ, −0.07 to 0.01) and α-angle (−0.06 to 0.17) and highest for MA (0.22-0.51) and LY30 (0.29-0.49). Choice of TEG method may impact clinical decision-making. rTEG appeared most sensitive in parameter-specific associations with injury severity, abnormal fibrinolysis, and mortality.
Funder
Systems Biology Coagulopathy of Trauma Defense Health Program U.S. Army Medical Research and Development Command
Publisher
Oxford University Press (OUP)
Subject
Rehabilitation,Emergency Medicine,Surgery
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