Document Type
Article
Publication Date
2-2020
Abstract
BACKGROUND
Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients.
METHODS
Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum amplitude (CFF.MA), citrated kaolin percent clot lysis at 30 minutes (CK.LY30), citrated RapidTEG maximum amplitude (CRT.MA), and citrated kaolin maximum amplitude (CK.MA) parameters in adults meeting full or limited trauma team criteria. Blood was drawn ≤1 hour after admission. Assays were repeated in duplicate. Reliability (TEG 5000 vs. TEG 6s analyzers) and repeatability (interdevice comparison) was quantified. Linear regression was used to define the relationship between TEG 6s and TEG 5000 devices.
RESULTS
A total of 475 patients were enrolled. The cohort was predominantly male (68.6%) with a median age of 49 years. Regression line slope estimates (ß) and linear correlation estimates (p) were as follows: CK.R (ß = 1.05, ρ = 0.9), CFF.MA (ß = 0.99, ρ = 0.95), CK.LY30 (ß = 1.01, ρ = 0.91), CRT.MA (TEG 6s) versus CK.MA (TEG 5000) (ß = 1.06, ρ = 0.86) as well as versus CRT.MA (TEG 5000) (ß = 0.93, ρ = 0.93), indicating strong reliability between the devices. Overall, within-device repeatability was better for TEG 6s versus TEG 5000, particularly for CFF.MA and CK.LY30.
CONCLUSION
The TEG 6s device appears to be highly reliable for use in trauma patients, with close correlation to the TEG 5000 device and equivalent/improved within-device reliability. Given the potential advantages of using the TEG 6s device at the site of care, confirmation of agreement between the devices represents an important advance in diagnostic testing.
LEVEL OF EVIDENCE
Diagnostic test, level II.
Repository Citation
Neal, Matthew D. MD, FACS; Moore, Ernest E. MD, FACS; Walsh, Mark MD; Thomas, Scott MD; Callcut, Rachael A. MD, MSPH; Kornblith, Lucy Z. MD; Schreiber, Martin MD; Ekeh, Akpofure Peter MD, MPH, FACS; Singer, Adam J. MD; Lottenberg, Lawrence MD, FACS; Foreman, Michael MD, FACS; Evans, Susan MD, FACS; Winfield, Robert D. MD, FACS; Goodman, Michael D. MD, FACS; Freeman, Carl MD; Milia, David MD; Saillant, Noelle MD; Hartmann, Jan MD; Achneck, Hardean E. MD. A comparison between the TEG 6s and TEG 5000 analyzers to assess coagulation in trauma patients. Journal of Trauma and Acute Care Surgery 88(2):p 279-285, February 2020. | DOI: 10.1097/TA.0000000000002545
DOI
10.1097/TA.0000000000002545
PMCID
PMC7004476
Comments
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.