A Comparative Analysis of Functional Fibrinogen Assays using TEG and ROTEM in Trauma Patients Enrolled in the FiiRST Trial
Bibliographic record
Abstract
Introduction: Given the growing use of both thrombelastography (TEG) and rotational thromboelastometry (ROTEM) in trauma and surgery, it is important to determine whether the two are interchangeable, and how comparable they are to Clauss fibrinogen assay and for clinical use.We recently completed a randomized control trial on early fibrinogen in trauma (the FiiRST trial).The object of this analysis was to evaluate the interchangeability and correlations between TEG and ROTEM functional fibrinogen assays in injured trauma patients.Also, we evaluated their correlation with Clauss fibrinogen and compared their potentials for diagnosis of coagulopathy and use in guided fibrinogen administration. Materials and Methods:The Post-hoc analysis of the coagulation data collected as part of the FiiRST trial.It was a comparative analysis of functional fibrinogen assays using TEG and ROTEM in trauma patients screened for hypotension and need for blood transfusion.TEG and ROTEM tests were also compared with Clauss fibrinogen assay and INR as additional analyses of their clinical use.Results: TEG and ROTEM parameter values were correlated but were significantly different, and their agreement fell outside acceptable limits and thus were not interchangeable.TEG maximum amplitude (MA) and ROTEM maximum clot firmness (MCF) showed closest correlations with Clauss fibrinogen concentration, particularly with ROTEM FIBTEM MCF (r = 0.84; p < 0.001).There were discrepancies between TEG and ROTEM in their detection of coagulation abnormalities, hypofibrinogenemia, and hyperfibrinolysis.Conclusion: TEG and ROTEM fibrinogen assay parameters were associated, especially between TEG MA and ROTEM MCF, showing the strongest correlation, but the parameters were not interchangeable.TEG and ROTEM showed varying extents of correlations with Clauss fibrinogen.Overall, ROTEM parameters exhibited better correlations with Clauss fibrinogen than TEG.Different algorithms for TEG and ROTEM need to be developed for diagnosis of coagulopathy and guided fibrinogen administration in trauma.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.015 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".