The "Death Diamond": Death Beyond Trauma.
Publication/Presentation Date
7-1-2019
Abstract
Thromboelastography (TEG) has become a critical tool for the diagnosis, assessment, and management of hyperfibrinolysis and coagulopathy in trauma. In 2015, Chapman et al. of the Denver group coined the term "Death Diamond" (DD) to describe a TEG tracing identified in a unique trauma population. The DD was associated with a 100 per cent positive predictive value for mortality. Given the potential prognostic implications and resource savings associated with validating the DD as a marker of futile care, we sought to further evaluate DD outcomes. A retrospective review of 6850 TEGs, 34 patients (24 trauma and 10 nontrauma), displayed a DD tracing. Through invasive procedures and transfusions, nine DD tracing "normalized," but, ultimately, this did not impact the outcome because the DD had a positive predictive value of 100 per cent for mortality in both populations. The median survival time in trauma patients was two hours compared with seven hours in nontrauma patients. Overall, this study further validates the predictive value of the DD in a trauma population while also serving as an assessment of the DD in a nontrauma population. Given these findings, a DD may prove to be an indicator of futile care. Further multicenter studies should be conducted to confirm these results.
Volume
85
Issue
7
First Page
757
Last Page
760
ISSN
1555-9823
Published In/Presented At
Farrell, M., Marconi, T., Jr, Getchell, J., Green, R., Cipolle, M., & Sixta, S. (2019). The "Death Diamond": Death Beyond Trauma. The American surgeon, 85(7), 757–760.
Disciplines
Medicine and Health Sciences
PubMedID
31405423
Department(s)
Department of Surgery
Document Type
Article