Prognostic Value of Thromboelastography Parameters for Early Trauma-Induced Coagulopathy in Severely Injured Patients: A Retrospective Cohort Study.

Authors

Gabriel Honnef, Philipp Zoidl, Barbara Hallmann, Moritz Missmann, Michael Eichinger, Maximilian Niederer, Paul Zajic

Published in

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. Volume 33. Issue 10. Pages e70423.

Abstract

Early trauma-induced coagulopathy (eTIC) is a major contributor to hemorrhage-related mortality after severe trauma. Viscoelastic testing using thromboelastography (TEG) has been increasingly implemented in trauma resuscitation; however, its prognostic value compared with conventional coagulation testing remains uncertain.
We evaluated the ability of TEG parameters to detect eTIC, hypofibrinogenemia, and hyperfibrinolysis in severely injured trauma patients. In addition, we assessed their prognostic performance for transfusion requirements and mortality compared with conventional laboratory parameters.
Retrospective single-center cohort study.
Severely injured adult trauma patients admitted to the resuscitation room of a Level I trauma center, between January 2019 and October 2024 were screened.
Primary outcomes were detection of eTIC (INR > 1.2), severe coagulopathy (INR > 1.5), hypofibrinogenemia (< 200 mg/dL), and thrombocytopenia (< 100,000/μL). Secondary outcomes included the ability of coagulation parameters to predict the need for transfusion of ≥ 5 units of packed red blood cells within the first 24 h after admission and in-hospital mortality.
A total of 262 patients were included; median ISS was 29 (IQR 23-41), and in-hospital mortality was 22.8%. eTIC was present in 31.5% of patients. TEG parameters showed moderate discriminatory performance for coagulopathy detection. For eTIC, maximum amplitude achieved an AUC of 0.73, while R-time achieved an AUC of 0.65. Predictive performance improved for severe coagulopathy, with R-time reaching an AUC of 0.81. Hyperfibrinolysis (LY30 > 7%) was uncommon (6.9%). Conventional laboratory parameters, particularly INR, consistently outperformed TEG-derived parameters for prediction of transfusion requirements (AUC 0.85) and mortality (AUC 0.79).
In severely injured trauma patients, conventional coagulation testing, particularly INR, demonstrated superior prognostic performance compared with individual TEG parameters. Viscoelastic testing may provide complementary information but did not replace standard laboratory testing for prediction of transfusion needs or mortality in this cohort.
ClinicalTrials.gov identifier: NCT07186712.

PMID:
42902959
Bibliographic data and abstract were imported from PubMed on 22 Oct 2026.

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