PROCEEDINGS Open Access TEG® and ROTEM® in trauma: similar test but different results? Ajith Sankarankutty 1,2 , Bartolomeu Nascimento 2 , Luis Teodoro da Luz 2 , Sandro Rizoli 3* From World Trauma Congress 2012 Rio de Janeiro, Brazil. 22-25 August 2012 Abstract Introduction: Transfusion in trauma is often empiric or based on traditional lab tests. Viscoelastic tests such as thromboelastography (TEG ® ) and rotational thromboelastometry (ROTEM ® ) have been proposed as superior to traditional lab tests. Due to the similarities between the two tests, general opinion seems to consider them equivalent with interchangeable interpretations. However, it is not clear whether the results can be similarly interpreted. This review evaluates the comparability between TEG and ROTEM and performs a descriptive review of the parameters utilized in each test in adult trauma patients. Methods: PUBMED database was reviewed using the keywords “thromboelastography” and “compare”, between 2000 and 2011. Original studies directly comparing TEG ® with ROTEM ® in any area were retrieved. To verify the individual test parameter used in studies involving trauma patients, we further performed a review using the keywords “thromboelastography” and “trauma” in the PUBMED database. Results: Only 4 studies directly compared TEG ® with ROTEM ® . One in liver transplantation found that transfusion practice could differ depending on the device in use. Another in cardiac surgery concluded that all measurements are not completely interchangeable. The third article using commercially available plasma detected clinically significant differences in the results from the two devices. The fourth one was a head-to-head comparison of the technical aspects. The 24 articles reporting the use of viscoelastic tests in trauma patients, presented considerable heterogeneity. Conclusion: Both tests are potentially useful as means to rapidly diagnose coagulopathy, guide transfusion and determine outcome in trauma patients. Differences in the activators utilized in each device limit the direct comparability. Standardization and robust clinical trials comparing the two technologies are needed before these tests can be widely recommended for clinical use in trauma. Introduction Coagulation is a complex, dynamic, highly regulated and interwoven process involving a myriad of cells, mole- cules and structures. Only recently, the unique changes in coagulation caused by trauma are starting to be understood, but remain mostly unknown [1,2]. Trauma patients are among the largest consumers of blood and blood products and the decision of what, when and how much blood and blood product to transfuse is often empiric or based on traditional coagulation lab tests such as INR/PT, PTT and platelet count. However, tra- ditional lab tests have been heavily criticized for their limitations in assisting the physicians with the clinical decision to transfuse, and alternatives are warranted. The traditional laboratorial evaluation of coagulation evolved initially to quantify specific cellular, molecular or factor deficiencies. Numeric values (quantity) of indi- vidual elements do not necessarily indicate how well hemostasis is functioning. As an example, a cirrhotic patient with low platelet count and an abnormal INR of 2 does not necessarily bleed and probably can tolerate minor invasive procedures. In contrast, a hypothermic * Correspondence: Sandro.Rizoli@sunnybrook.ca 3 Departments of Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada Full list of author information is available at the end of the article Sankarankutty et al. World Journal of Emergency Surgery 2012, 7(Suppl 1):S3 http://www.wjes.org/content/7/S1/S3 WORLD JOURNAL OF EMERGENCY SURGERY © 2012 Sankarankutty et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.