{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:18:30Z","timestamp":1789471110808,"version":"build-2803163510"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100010653","name":"Masaryk University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100010653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      Trauma-induced coagulopathy affects approximately one-quarter of polytrauma patients and is associated with increased mortality. Given the central role of fibrinogen and its early depletion after injury, supplementation is recommended after hospital admission in the presence of hypofibrinogenaemia or suspected major haemorrhage. As coagulopathy develops within minutes of trauma, prehospital fibrinogen administration may help mitigate its progression before hospital arrival. This study evaluated the incidence of coagulopathy at hospital admission, assessed using ROTEM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      , among polytrauma patients receiving fibrinogen concentrate in the prehospital setting.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single-centre, prospective observational study, adult patients with polytrauma (Injury Severity Score\u2009\u2265\u200916) were enrolled after prehospital administration of fibrinogen concentrate. The primary outcome was the presence of coagulopathy at hospital arrival, defined according to predefined ROTEM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      Delta thresholds (FIBTEM MCF\u2009\u2264\u20098\u00a0mm and\/or EXTEM CT\u2009\u2265\u200980\u00a0s and\/or EXTEM MCF\u2009\u2264\u200949\u00a0mm). The secondary outcomes were laboratory coagulation status, 28-day all-cause mortality, and thromboembolic complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty patients were enrolled, of whom 28 were included in the final analysis. Twenty-seven patients received 4\u00a0g of fibrinogen concentrate and one received 2\u00a0g due to short transport time. ROTEM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      -defined coagulopathy was identified in two patients (7.1%), both based on EXTEM abnormalities; no patient had reduced FIBTEM MCF. Five patients (17.9%) died within 28 days and two patients (7.1%) experienced thromboembolic complications.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Our findings describe a low incidence of ROTEM\n                      <jats:sup>\u00ae<\/jats:sup>\n                      -defined coagulopathy at hospital arrival in polytrauma patients who received prehospital fibrinogen concentrate. Adequately powered randomized controlled trials are required to determine whether prehospital fibrinogen administration reduces coagulopathy and improves clinically relevant outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>NCT03572309, ClinicalTrials.gov, registered on 19 June 2018.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00068-026-03183-8","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T10:25:23Z","timestamp":1777026323000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence of ROTEM\u00ae-defined coagulopathy at hospital arrival among polytrauma patients receiving fibrinogen concentrate in prehospital setting: a prospective observational study"],"prefix":"10.1007","volume":"52","author":[{"given":"Kamil","family":"Vrbica","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filip","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Stingl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Vanickova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radka","family":"Stepanova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Dolecek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondrej","family":"Hrdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Gal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"3183_CR1","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/s40560-016-0196-6","volume":"5","author":"S Kushimoto","year":"2017","unstructured":"Kushimoto S, Kudo D, Kawazoe Y. Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview. J Intensive Care. 2017;5:6. https:\/\/doi.org\/10.1186\/s40560-016-0196-6.","journal-title":"J Intensive Care"},{"key":"3183_CR2","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1038\/s41572-021-00264-3","volume":"7","author":"EE Moore","year":"2021","unstructured":"Moore EE, Moore HB, Kornblith LZ, Neal MD, Hoffman M, Mutch NJ, et al. Trauma-induced coagulopathy. Nat Rev Dis Primers. 2021;7:30. https:\/\/doi.org\/10.1038\/s41572-021-00264-3.","journal-title":"Nat Rev Dis Primers"},{"key":"3183_CR3","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1097\/01.TA.0000069184.82147.06","volume":"54","author":"K Brohi","year":"2003","unstructured":"Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127\u201330. https:\/\/doi.org\/10.1097\/01.TA.0000069184.82147.06.","journal-title":"J Trauma"},{"key":"3183_CR4","first-page":"12","volume":"1","author":"M Maegele","year":"2010","unstructured":"Maegele M. Acute traumatic coagulopathy: Incidence, risk stratification and therapeutic options. World J Emerg Med. 2010;1:12\u201321.","journal-title":"World J Emerg Med"},{"key":"3183_CR5","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1757-7241-20-15","volume":"20","author":"H Sch\u00f6chl","year":"2012","unstructured":"Sch\u00f6chl H, Maegele M, Solomon C, G\u00f6rlinger K, Voelckel W. Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med. 2012;20:15. https:\/\/doi.org\/10.1186\/1757-7241-20-15.","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"3183_CR6","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1111\/j.1538-7836.2012.04752.x","volume":"10","author":"C Rourke","year":"2012","unstructured":"Rourke C, Curry N, Khan S, Taylor R, Raza I, Davenport R, et al. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost. 2012;10:1342\u201351. https:\/\/doi.org\/10.1111\/j.1538-7836.2012.04752.x.","journal-title":"J Thromb Haemost"},{"key":"3183_CR7","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1093\/bja\/aeq161","volume":"105","author":"D Fries","year":"2010","unstructured":"Fries D, Martini WZ. Role of fibrinogen in trauma-induced coagulopathy. Br J Anaesth. 2010;105:116\u201321. https:\/\/doi.org\/10.1093\/bja\/aeq161.","journal-title":"Br J Anaesth"},{"key":"3183_CR8","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/s13054-023-04327-7","volume":"27","author":"R Rossaint","year":"2023","unstructured":"Rossaint R, Afshari A, Bouillon B, Cerny V, Cimpoesu D, Curry N, et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care. 2023;27:80. https:\/\/doi.org\/10.1186\/s13054-023-04327-7.","journal-title":"Crit Care"},{"key":"3183_CR9","doi-asserted-by":"publisher","first-page":"1882","DOI":"10.1001\/jama.2023.21019","volume":"330","author":"R Davenport","year":"2023","unstructured":"Davenport R, Curry N, Fox EE, Thomas H, Lucas J, Evans A, et al. Early and Empirical High-Dose Cryoprecipitate for Hemorrhage After Traumatic Injury: The CRYOSTAT-2 Randomized Clinical Trial. JAMA. 2023;330:1882\u201391. https:\/\/doi.org\/10.1001\/jama.2023.21019.","journal-title":"JAMA"},{"key":"3183_CR10","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1055\/s-0034-1398379","volume":"41","author":"M Hayakawa","year":"2015","unstructured":"Hayakawa M, Gando S, Ono Y, Wada T, Yanagida Y, Sawamura A. Fibrinogen level deteriorates before other routine coagulation parameters and massive transfusion in the early phase of severe trauma: a retrospective observational study. Semin Thromb Hemost. 2015;41:35\u201342. https:\/\/doi.org\/10.1055\/s-0034-1398379.","journal-title":"Semin Thromb Hemost"},{"key":"3183_CR11","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1136\/emermed-2019-209181","volume":"37","author":"TJ Coats","year":"2020","unstructured":"Coats TJ, Morsy M. Biological mechanisms and individual variation in fibrinolysis after major trauma. Emerg Med J. 2020;37:135\u201340. https:\/\/doi.org\/10.1136\/emermed-2019-209181.","journal-title":"Emerg Med J"},{"key":"3183_CR12","doi-asserted-by":"publisher","first-page":"1220","DOI":"10.1097\/TA.0000000000000657","volume":"78","author":"K Inaba","year":"2015","unstructured":"Inaba K, Rizoli S, Veigas PV, Callum J, Davenport R, Hess J, et al. 2014 Consensus conference on viscoelastic test-based transfusion guidelines for early trauma resuscitation: Report of the panel. J Trauma Acute Care Surg. 2015;78:1220\u20139. https:\/\/doi.org\/10.1097\/TA.0000000000000657.","journal-title":"J Trauma Acute Care Surg"},{"key":"3183_CR13","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","volume":"370","author":"E von Elm","year":"2007","unstructured":"von Elm E, Altman DG, Egger M, Pocock SJ, G\u00f8tzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370:1453\u20137. https:\/\/doi.org\/10.1016\/S0140-6736(07)61602-X.","journal-title":"Lancet"},{"key":"3183_CR14","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1097\/SHK.0000000000002416","volume":"62","author":"W Teeter","year":"2024","unstructured":"Teeter W, Neal MD, Brown JB, MacLeod JBA, Vesselinov R, Kozar RA, TRAUMA-INDUCED COAGULOPATHY. PREVALENCE AND ASSOCIATION WITH MORTALITY PERSIST 20 YEARS LATER. Shock. 2024;62:380\u20135. https:\/\/doi.org\/10.1097\/SHK.0000000000002416.","journal-title":"Shock"},{"key":"3183_CR15","doi-asserted-by":"publisher","first-page":"348","DOI":"10.1097\/EJA.0000000000001366","volume":"38","author":"B Ziegler","year":"2021","unstructured":"Ziegler B, Bachler M, Haberfellner H, Niederwanger C, Innerhofer P, Hell T, et al. Efficacy of prehospital administration of fibrinogen concentrate in trauma patients bleeding or presumed to bleed (FIinTIC): A multicentre, double-blind, placebo-controlled, randomised pilot study. Eur J Anaesthesiol. 2021;38:348\u201357. https:\/\/doi.org\/10.1097\/EJA.0000000000001366.","journal-title":"Eur J Anaesthesiol"},{"key":"3183_CR16","doi-asserted-by":"publisher","first-page":"1148","DOI":"10.3390\/diagnostics15091148","volume":"15","author":"M Asim","year":"2025","unstructured":"Asim M, El-Menyar A, Peralta R, Arumugam S, Wahlen B, Ahmed K, et al. Clinical Significance of Rotational Thromboelastometry (ROTEM) for Detection of Early Coagulopathy in Trauma Patients: A Retrospective Study. Diagnostics (Basel). 2025;15:1148. https:\/\/doi.org\/10.3390\/diagnostics15091148.","journal-title":"Diagnostics (Basel)"},{"key":"3183_CR17","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1093\/bja\/aer158","volume":"107","author":"H Tauber","year":"2011","unstructured":"Tauber H, Innerhofer P, Breitkopf R, Westermann I, Beer R, El Attal R, et al. Prevalence and impact of abnormal ROTEM(R) assays in severe blunt trauma: results of the Diagnosis and Treatment of Trauma-Induced Coagulopathy (DIA-TRE-TIC) study. Br J Anaesth. 2011;107:378\u201387. https:\/\/doi.org\/10.1093\/bja\/aer158.","journal-title":"Br J Anaesth"},{"key":"3183_CR18","doi-asserted-by":"publisher","first-page":"e258","DOI":"10.1016\/S2352-3026(17)30077-7","volume":"4","author":"P Innerhofer","year":"2017","unstructured":"Innerhofer P, Fries D, Mittermayr M, Innerhofer N, von Langen D, Hell T, et al. Reversal of trauma-induced coagulopathy using first-line coagulation factor concentrates or fresh frozen plasma (RETIC): a single-centre, parallel-group, open-label, randomised trial. Lancet Haematol. 2017;4:e258\u201371. https:\/\/doi.org\/10.1016\/S2352-3026(17)30077-7.","journal-title":"Lancet Haematol"},{"key":"3183_CR19","doi-asserted-by":"publisher","unstructured":"Richards J, Fedeles BT, Chow JH, Scalea T, Kozar R. Raising the bar on fibrinogen: a retrospective assessment of critical hypofibrinogenemia in severely injured trauma patients. Trauma Surg Acute Care Open. 2023;8. https:\/\/doi.org\/10.1136\/tsaco-2022-000937.","DOI":"10.1136\/tsaco-2022-000937"},{"key":"3183_CR20","doi-asserted-by":"publisher","first-page":"32","DOI":"10.51893\/2021.1.OA3","volume":"23","author":"J Winearls","year":"2021","unstructured":"Winearls J, Wullschleger M, Wake E, McQuilten Z, Reade M, Hurn C, et al. Fibrinogen Early In Severe Trauma studY (FEISTY): results from an Australian multicentre randomised controlled pilot trial. Crit Care Resusc. 2021;23:32\u201346. https:\/\/doi.org\/10.51893\/2021.1.OA3.","journal-title":"Crit Care Resusc"},{"key":"3183_CR21","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1097\/TA.0000000000003728","volume":"93","author":"O Obaid","year":"2022","unstructured":"Obaid O, Anand T, Nelson A, Reina R, Ditillo M, Stewart C, et al. Fibrinogen supplementation for the trauma patient: Should you choose fibrinogen concentrate over cryoprecipitate? J Trauma Acute Care Surg. 2022;93:453\u201360. https:\/\/doi.org\/10.1097\/TA.0000000000003728.","journal-title":"J Trauma Acute Care Surg"},{"key":"3183_CR22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1186\/s13017-020-0291-9","volume":"15","author":"Y Itagaki","year":"2020","unstructured":"Itagaki Y, Hayakawa M, Maekawa K, Saito T, Kodate A, Honma Y, et al. Early administration of fibrinogen concentrate is associated with improved survival among severe trauma patients: a single-centre propensity score-matched analysis. World J Emerg Surg. 2020;15:7. https:\/\/doi.org\/10.1186\/s13017-020-0291-9.","journal-title":"World J Emerg Surg"},{"key":"3183_CR23","doi-asserted-by":"publisher","first-page":"e2532702","DOI":"10.1001\/jamanetworkopen.2025.32702","volume":"8","author":"LT da Luz","year":"2025","unstructured":"da Luz LT, Karkouti K, Carroll J, Grewal D, Jones M, Altmann J, et al. Factors in the Initial Resuscitation of Patients With Severe Trauma: The FiiRST-2 Randomized Clinical Trial. JAMA Netw Open. 2025;8:e2532702. https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.32702.","journal-title":"JAMA Netw Open"},{"key":"3183_CR24","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1186\/s13054-025-05269-y","volume":"29","author":"T Burt","year":"2025","unstructured":"Burt T, Guilliam A, Cole E, Davenport R. Effect of early administration of fibrinogen replacement therapy in traumatic haemorrhage: a systematic review and meta-analysis of randomised controlled trials with narrative synthesis of observational studies. Crit Care. 2025;29:49. https:\/\/doi.org\/10.1186\/s13054-025-05269-y.","journal-title":"Crit Care"},{"key":"3183_CR25","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1186\/s13054-018-2086-x","volume":"22","author":"N Curry","year":"2018","unstructured":"Curry N, Foley C, Wong H, Mora A, Curnow E, Zarankaite A, et al. Early fibrinogen concentrate therapy for major haemorrhage in trauma (E-FIT 1): results from a UK multi-centre, randomised, double blind, placebo-controlled pilot trial. Crit Care. 2018;22:164. https:\/\/doi.org\/10.1186\/s13054-018-2086-x.","journal-title":"Crit Care"},{"key":"3183_CR26","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1093\/bja\/aew343","volume":"117","author":"B Nascimento","year":"2016","unstructured":"Nascimento B, Callum J, Tien H, Peng H, Rizoli S, Karanicolas P, et al. Fibrinogen in the initial resuscitation of severe trauma (FiiRST): a randomized feasibility trial. Br J Anaesth. 2016;117:775\u201382. https:\/\/doi.org\/10.1093\/bja\/aew343.","journal-title":"Br J Anaesth"},{"key":"3183_CR27","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1097\/01.ta.0000220386.84012.bf","volume":"60","author":"N Y\u00fccel","year":"2006","unstructured":"Y\u00fccel N, Lefering R, Maegele M, Vorweg M, Tjardes T, Ruchholtz S, et al. Trauma Associated Severe Hemorrhage (TASH)-Score: Probability of Mass Transfusion as Surrogate for Life Threatening Hemorrhage after Multiple Trauma. J Trauma Acute Care Surg. 2006;60:1228. https:\/\/doi.org\/10.1097\/01.ta.0000220386.84012.bf.","journal-title":"J Trauma Acute Care Surg"},{"key":"3183_CR28","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1097\/TA.0000000000000200","volume":"76","author":"T Ogura","year":"2014","unstructured":"Ogura T, Nakamura Y, Nakano M, Izawa Y, Nakamura M, Fujizuka K, et al. Predicting the need for massive transfusion in trauma patients: The Traumatic Bleeding Severity Score. J Trauma Acute Care Surg. 2014;76:1243. https:\/\/doi.org\/10.1097\/TA.0000000000000200.","journal-title":"J Trauma Acute Care Surg"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03183-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-026-03183-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-026-03183-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:40:04Z","timestamp":1781649604000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-026-03183-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3183"],"URL":"https:\/\/doi.org\/10.1007\/s00068-026-03183-8","relation":{},"ISSN":["1863-9941"],"issn-type":[{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"2 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the guidelines of the Declaration of Helsinki and received approval from the Ethics Committee of University Hospital Brno (Approval No.: No. 01-160518).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"In the past 5 years, KVr, KVa and RG have received honoraria for lecturing from CSL Behring. All the remaining authors declare no conflict of interest.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"144"}}