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Table 5 Studies addressing ROTEM® thresholds used to predict or guide blood transfusion

From: A systematic review on the rotational thrombelastometry (ROTEM®) values for the diagnosis of coagulopathy, prediction and guidance of blood transfusion and prediction of mortality in trauma patients

Study

Comparator

ROTEM® thresholds used

Accuracy of threshold

Sensitivity/Specificity

ROC/AUC

Key findings

Massive transfusion

 Leemann 2010 [38]

aPTT > 36 s

PLT < 100 × 103

INR > 1.2

EXTEM/INTEM CA10, CA20, CFT, MCF

as per manufacturer

NA

NA

0.82

2 – INTEM MCF 37.5 ± 2.9 associated with MT requirements within 24 h

 Tauber, 2011 [40]

FIB 1.50 g/L

INR > 1.5

FIBTEM MCF < 7 mm

71

NA

0.80

1 – FIBTEM MCF < 7 mm associated with RBC use (OR 0.92, 95 % CI 0.87–0.98)

 Schochl 2011 [28]

PLT ≤ 161 × 103

aPTT ≤ 35.2 s

FIB ≤ 1.4 g/dL

FIBTEM A10 ≤ 4 mm

FIBTEM MCF ≤ 7 mm

63.3

77.5

83.2

74.9

0.83

0.84

1 – 85 % patients with FIBTEM MCF

0–3 mm received MT

2 – FIBTEM A10 (0.83) and FIBTEM MCF (0.84) showed high predictive value for MT

 Davenport 2011 [41]

PTR > 1.2

EXTEM CA5 ≤ 35 mm

71.4 %

NA

NA

1 – CA5 identified patients who required MT with detection rate of 71 % vs. 43 % for PTR > 1.2, p < 0.001

 Hagemo 2015 [43]

INR > 1.2

EXTEM CA5 ≤ 40 mm

FIBTEM CA5 ≤ 9 mm

72.7 %

77.5 %

0.75

0.78

1 – ROTEM CA5 is a valid predictor for MT.

Any transfusion

 Schochl, 2010 [27]

PT (11–13.5 s)

aPTT (26-35 s)

FIB (2–4.5 g/L)

PLT (150–350)

FIBTEM MCF < 10 mm

EXTEM CT > 1.5× normal

NA

NA

NA

1 – ROTEM® guided FC and PCC transfusion, associated with favorable survival (24.4 % vs. 33.7 %; p = 0.032)

 Davenport 2011 [41]

PTR > 1.2

EXTEM CA5 ≤ 35 mm

CT > 94 s

Alpha < 650

33.3 %

NA

NA

1 – CA5 ≤ 35 mm predicted RBC and plasma transfusion. Patients with CA5 ≤ 35 mm received more RBC (46 % vs. 17 %, p < 0.001) and plasma (37 % vs. 11 %, p < 0.001) transfusions.

2 – CA5 ≤ 35 mm received more RBC (4U vs. 1U, p < 0.001) and FFP (2U vs. 0U, p < 0.001)

  1. Legend: aPTT activated partial thromboplastin time, CA clot amplitude (measured at 5, 10, 15, 20 min, etc.), CT clotting time, CFT clot formation time, ED emergency department, EXTEM extrinsically activated test with tissue factor; FIB fibrinogen, FC fibrinogen concentrate, FFP fresh frozen plasma, FIBTEM fibrin-based extrinsically activated test with tissue factor and the platelet inhibitor cytochalasin D, GCS Glasgow coma scale, HGB hemoglobin, INR international normalized ratio, ISS injury severity score, MCF maximum clot firmness, MT massive transfusion, NA not available, PC platelet concentrate, PCC prothrombin complex concentrate, PLT platelets, RBC red blood cells, PT prothrombin time, PTI prothrombin time index, PTR prothrombin time ratio, RBC red blood cells