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Master Thesis

Impact médico-économique de l'utilisation du thromboélastogramme sur la prise en charge transfusionnelle du patient polytraumatisé

Abstract : Introduction: Currently, there is no clinical study measuring medical and economic impact of using thromboelametry on transfusion strategy in severe trauma patients. This study aims to compare the use of blood products and coagulation factors in trauma patients before and after the establishment of a thromboelastogram and evaluate economic impact. Materials and methods: Observational, single center, before and after study, including all trauma patients with ISS ≥ 13, admitted to Annecy hospital from October 2010 to July 2012. Patients were divided into two groups, before and after introduction of ROTEM® in July 2011. Demographic, initial severity, transfusion (measure and cost), length of stay and hospital death data were collected and compared between the two groups. Results: 214 patients were included, 105 (49%) in the period after ROTEM®, among whom 48 (46%) had a ROTEM®. Mean age was 44.1 (+/-18.6) years and average ISS was 28.4 (+/-12, 3). Death rate was 15.4%, significantly higher in the period after ROTEM® (20.9% vs. 10.1% prior period, p = 0.014). There was no statistical difference between the two periods for number of blood products received or hospital length of stay. Blood products administration cost was comparable between the two periods, but with a different distribution: lower transfusion of RBC and FFP and increase prescription of fibrinogen in the group after ROTEM®. Conclusion: Combination of ROTEM® analysis, use of diagnostic and therapeutic algorithm and fibrinogen tends to reduce transfusion of blood products in severe trauma patients. The cost generated by the prescription of blood products remains similar due to higher administration of fibrinogen.
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Master Thesis
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Submitted on : Friday, February 7, 2014 - 3:08:17 PM
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  • HAL Id : dumas-00943400, version 1

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Etienne Escudier. Impact médico-économique de l'utilisation du thromboélastogramme sur la prise en charge transfusionnelle du patient polytraumatisé. Médecine humaine et pathologie. 2013. ⟨dumas-00943400⟩

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