The “Death Diamond”: Death beyond Trauma

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...

Full description

Saved in:
Bibliographic Details
Published in:The American surgeon 2019-07, Vol.85 (7), p.757-760
Main Authors: Farrell, Michael, Marconi, Thomas, Getchell, John, Green, Raymond, Cipolle, Mark, Sixta, Sherry
Format: Article
Language:English
Subjects:
Adult
Aged
Blood Coagulation Disorders - diagnosis
Blood products
Death
Diamond tools
Female
Fibrinolysis
Humans
Male
Medical prognosis
Medical records
Middle Aged
Mortality
Patients
Population
Predictive Value of Tests
Retrospective Studies
Studies
Thrombelastography - methods
Trauma
Wounds and Injuries - diagnosis
Citations: Items that this one cites
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary: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.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481908500738