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Thrombelastography (TEG) is used to rapidly assess coagulation abnormalities in cardiac and transplant surgery. The purpose of this study was to investigate TEG in the initial assessment of trauma patient coagulation. TEG was performed on 69 adult blunt trauma patients during their initial evaluation. Demographics, history of inherited coagulopathies, medications, TEG parameters, platelet count, prothrombin time/partial thromboplastin time, Revised Trauma Score (RTS), Injury Severity Score (ISS), use of blood products, and outcome were recorded. Mortality was 4.3%. Fifty-two patients demonstrated coagulation abnormalities by TEG; of these, 45 were hypercoagulable (mean ISS 13.1), and seven were hypocoagulable (mean ISS 28.6). Six of the seven hypocoagulable patients received blood transfusions within the first 24 hours. Mean ISS of the 17 patients with normal TEG parameters was 3.7. Logistic regression of ISS, Revised Trauma Score, prothrombin time/partial thromboplastin time, and TEG on use/nonuse of blood products within the first 24 hours demonstrates that only ISS (p < 0.001) and TEG (p < 0.05) are predictive of early transfusion. The majority of blunt trauma patients in this series were hypercoagulable. TEG is a rapid, simple test that can broadly determine coagulation abnormalities. TEG is an early predictor of transfusion in blunt injury patients.