Initial TEG 6s parameters for risk stratification of hemorrhage-related outcomes in massively transfused trauma patients

While thromboelastography (TEG) and rotational thromboelastometry (ROTEM) allow rapid coagulation assessment, the prognostic value of arrival TEG 6s remains unclear. We examined the association between initial TEG 6s findings and in-hospital mortality and early transfusion requirements in trauma patients undergoing massive transfusion, excluding severe traumatic brain injury to better assess hemorrhage-related outcomes. This retrospective study included trauma patients who received massive transfusion and TEG 6s testing upon arrival at a Level I trauma center in South Korea. Patients with transfers, incomplete records, or head/neck AIS ≥ 3 were excluded. TEG 6s parameters were classified using published thresholds. Multivariable logistic and linear regression analyses evaluated associations with in-hospital mortality and RBC transfusion volumes at 4 and 24 h. Among 194 patients, 54.1% had abnormal TEG 6s results. These patients received higher RBC transfusion volumes at 4 and 24 h, and had higher in-hospital mortality. Abnormal TEG 6s findings were associated with higher in-hospital mortality in the multivariable analysis (adjusted OR 3.505, p = 0.050) and increased transfusion volume at 4 h (B = 1.686, p = 0.023) and 24 h (B = 2.313, p = 0.042). Initial TEG 6s abnormalities were associated with in-hospital mortality and early RBC transfusion in trauma patients undergoing massive transfusion. In massively transfused patients without severe traumatic brain injury, these findings suggest that arrival TEG 6s parameters may aid early risk stratification for hemorrhage-related outcomes.