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:
CreatorsEmailORCIDORCID Put Code
Froehlich, MatthiasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mutschler, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Caspers, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Nienaber, UlrikeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Jaecker, VeraUNSPECIFIEDorcid.org/0000-0001-8224-2414UNSPECIFIED
Driessen, ArneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bouillon, BertilUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maegele, MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
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:
KeywordsLanguage
INCREASED MORTALITY; RESUSCITATION; REGISTRY; INJURY; REPLACEMENT; MECHANISMS; HEMORRHAGEMultiple languages
Emergency MedicineMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/15759

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