Universität zu Köln

Froehlich, Matthias, Mutschler, Manuel, Caspers, Michael, Nienaber, Ulrike, Jaecker, Vera ORCID: 0000-0001-8224-2414, Driessen, Arne, Bouillon, Bertil and Maegele, Marc (2019). Trauma-induced coagulopathy upon emergency room arrival: still a significant problem despite increased awareness and management? Eur. J. Trauma Emerg. Surg., 45 (1). S. 115 - 125. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1863-9941

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Abstract

PurposeOver the last decade, the pivotal role of trauma-induced coagulopathy has been described and principal drivers have been identified. We hypothesized that the increased knowledge on coagulopathy of trauma would translate into a more cautious treatment, and therefore, into a reduced overall incidence rate of coagulopathy upon ER admission.Patients and methodsBetween 2002 and 2013, 61,212 trauma patients derived from the TraumaRegister DGU (R) had a full record of coagulation parameters and were assessed for the presence of coagulopathy. Coagulopathy was defined by a Quick's value<70% and/or platelet counts<100,000/mu l upon ER admission. For each year, the incidence of coagulopathy, the amount of pre-hospital administered i.v.-fluids and transfusion requirements were assessed.ResultsCoagulopathy upon ER admission was present in 24.5% of all trauma patients. Within the years 2002-2013, the annual incidence of coagulopathy decreased from 35 to 20%. Even in most severely injured patients (ISS>50), the incidence of coagulopathy was reduced by 7%. Regardless of the injury severity, the amount of pre-hospital i.v.-fluids declined during the observed period by 51%. Simultaneously, morbidity and mortality of severely injured patients were on the decrease.ConclusionDuring the 12years observed, a substantial decline of coagulopathy has been observed. This was paralleled by a significant decrease of i.v.-fluids administered in the pre-hospital treatment. The reduced presence of coagulopathy translated into decreased transfusion requirements and mortality. Nevertheless, especially in the most severely injured patients, posttraumatic coagulopathy remains a frequent and life-threatening syndrome.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Froehlich, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Mutschler, Manuel UNSPECIFIED UNSPECIFIED UNSPECIFIED Caspers, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Nienaber, Ulrike UNSPECIFIED UNSPECIFIED UNSPECIFIED Jaecker, Vera UNSPECIFIED orcid.org/0000-0001-8224-2414 UNSPECIFIED Driessen, Arne UNSPECIFIED UNSPECIFIED UNSPECIFIED Bouillon, Bertil UNSPECIFIED UNSPECIFIED UNSPECIFIED Maegele, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-157595
DOI:	10.1007/s00068-017-0884-5
Journal or Publication Title:	Eur. J. Trauma Emerg. Surg.
Volume:	45
Number:	1
Page Range:	S. 115 - 125
Date:	2019
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1863-9941
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INCREASED MORTALITY; RESUSCITATION; REGISTRY; INJURY; REPLACEMENT; MECHANISMS; HEMORRHAGE Multiple languages Emergency Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15759