Evaluation of thromboelastography for detection of coagulation after isolated traumatic brain injury

In the setting of haemorrhagic shock requiring massive transfusion, management is preemptive with transfusion of blood and blood products commenced in pre-defined ratios with the objective of avoiding and treating coagulopathy. However, in the setting of trauma where transfusion of red cells is not indicated, the management of coagulopathy may lag, is often guided by blood test results that represent an historic haemostatic milieu and the coagulopathy is associated with poor outcomes.

TEG® is based on the principle that the result of the hemostatic process is a clot whose physical properties determine hemostatic status of the pt. It provides global information on the dynamics of clot development, stabilization, and dissolution, reflecting in vivo hemostasis, and assesses both thrombosis and fibrinolysis. Rapidly growing observational evidence on the use of TEG exists in both multiply injured patients and in the setting of iTBI, but evidence is limited by lack of randomised controlled trials during trauma resuscitation. Thromboelastography may be useful for diagnosis of early trauma coagulopathies, specifically hypocoagulability, hypercoagulability, hyperfibrinolysis, and platelet dysfunction. TEG may also be used to direct blood and blood-product transfusion; effects on patient-important outcomes are uncertain.