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Open Access

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

Gerard S Doyle, Aristotle A Theodore, J Nicholas Hansen
DOI: 10.1136/tsaco-2016-000049 Published 2 March 2017
Gerard S Doyle
Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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Aristotle A Theodore
Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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J Nicholas Hansen
Division of Emergency Medicine, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
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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.

Footnotes

  • Contributors GSD designed the study. GSD, AAT, and JNH collected and processed data and managed the study and databases. GSD, AAT, and JNH prepared and edited the manuscript.

  • Competing interests None declared.

  • Ethics approval University of Utah IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study
Gerard S Doyle, Aristotle A Theodore, J Nicholas Hansen
Trauma Surg Acute Care Open Mar 2017, 2 (1) e000049; DOI: 10.1136/tsaco-2016-000049

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Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study
Gerard S Doyle, Aristotle A Theodore, J Nicholas Hansen
Trauma Surg Acute Care Open Mar 2017, 2 (1) e000049; DOI: 10.1136/tsaco-2016-000049
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Impact thromboelastometry (ITEM) for point-of-injury detection of trauma-induced coagulopathy: a pilot study
Gerard S Doyle, Aristotle A Theodore, J Nicholas Hansen
Trauma Surgery & Acute Care Open Mar 2017, 2 (1) e000049; DOI: 10.1136/tsaco-2016-000049
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