Frequency, risk stratification and therapeutic management of acute post-traumatic coagulopathy

Author: Maegele, M.

Source: Vox Sanguinis, Volume 97, Number 1, July 2009 , pp. 39-49(11)

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Abstract:

Background

Uncontrolled haemorrhage is still responsible for more than 50% of all trauma-related deaths within the first 48 h after hospital admission. Clinical observations together with recent research resulted in a new appreciation of the central role of coagulopathy in acute trauma care. A synopsis of different analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU)/German Society of Trauma Surgery) with respect to incidence, risk stratification and therapeutic management of acute post-traumatic coagulopathy is presented. Methods

Retrospective analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database and development/validation of a scoring system (TASH score = trauma-associated severe haemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening haemorrhage after severe multiple injuries. Results/conclusion

There is a high frequency of acute post-traumatic coagulopathy already present upon ER admission which is associated with significant morbidity and mortality in multiple-injured patients. The TASH score is recognized as an easy-to-calculate and valid scoring system to predict the individual's probability for massive transfusion and thus ongoing life-threatening haemorrhage at a very early stage after severe multiple injuries. An early aggressive management of acute post-traumatic coagulopathy including a more balanced administration of blood products to favour improved outcome is advocated.

Keywords: coagulopathy; epidemiology; management; risk stratification; trauma

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1423-0410.2009.01179.x

Publication date: 2009-07-01

Frequency, risk stratification and therapeutic management of acute post-traumatic coagulopathy

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