The Addition of ROTEM Parameter Did Not Significantly Improve the Massive Transfusion Prediction in Severe Trauma Patients

Dongyup Baik; Seok-Ran Yeom; Sung-Wook Park; Youngmo Cho; Wook Tae Yang; Hoon Kwon; Jae Il Lee; Jun-Kyeung Ko; Hyuk Jin Choi; Up Huh; Tae Sik Goh; Chan-Hee Song; Lee Hwangbo; Il Jae Wang

doi:10.1155/2022/7219812

The Addition of ROTEM Parameter Did Not Significantly Improve the Massive Transfusion Prediction in Severe Trauma Patients

Emerg Med Int. 2022 Oct 15:2022:7219812. doi: 10.1155/2022/7219812. eCollection 2022.

Authors

Affiliations

¹ Department of Emergency Medicine, School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea.
² Department of Radiology, Biomedical Research Institute, Pusan National University Department of Radiology, Busan 49241, Republic of Korea.
³ Department of Neurosurgery, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea.
⁴ Department of Thoracic and Cardiovascular Surgery, School of Medicine, Pusan National University, and Biomedical Research Institute, Pusan National University Hospital, Busan 49241, Republic of Korea.
⁵ Department of Orthopaedic Surgery, Biomedical Research Institute, Busan National University Hospital, Busan National University School of Medicine, Busan 49241, Republic of Korea.
⁶ Department of Biomedical Engineering, Graduate School, Pusan National University, Busan 49241, Republic of Korea.

Abstract

Background: Rotational thrombelastometry (ROTEM) has been used to evaluate the coagulation state, predict transfusion, and optimize hemostatic management in trauma patients. However, there were limited studies on whether the prediction value could be improved by adding the ROTEM parameter to the prediction model for in-hospital mortality and massive transfusion (MT) in trauma patients.

Objective: This study assessed whether ROTEM data could improve the MT prediction model.

Method: This was a single-center, retrospective study. Patients who presented to the trauma center and underwent ROTEM between 2016 and 2020 were included. The primary and secondary outcomes were massive transfusions and in-hospital mortality, respectively. We constructed two models using multivariate logistic regression with backward conditional stepwise elimination (Model 1: without the ROTEM parameter and Model 2: with the ROTEM parameter). The area under the receiver operating characteristic curve (AUROC) was calculated to assess the predictive ability of the models.

Result: In total, 969 patients were included; 196 (20.2%) received MT. The in-hospital mortality rate was 14.1%. For MT, the AUROC was 0.854 (95% confidence interval [CI], 0.825-0.883) and 0.860 (95% CI, 0.832-0.888) for Model 1 and 2, respectively. For in-hospital mortality, the AUROC was 0.886 (95% CI, 0.857-0.915) and 0.889 (95% CI, 0.861-0.918) for models 1 and 2, respectively. The AUROC values for models 1 and 2 were not statistically different for either MT or in-hospital mortality.

Conclusion: We found that the addition of the ROTEM parameter did not significantly improve the predictive power of MT and in-hospital mortality in trauma patients.