Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

Driessen, Arne; Schäfer, Nadine; Albrecht, Valérie; Fröhlich, Matthias; Stürmer, Ewa K.; Maegele, Marc; partners, Tactic

doi:10.1007/s00068-014-0455-y

Cited by 9 publications

(5 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Persistent higher odds for osteoporosis therapy after 120 days of follow-up confirmed these findings. This is in line with previous studies, which demonstrated that differences in infrastructure, logistics and clinical practice in the management of trauma patients have significant impact on patients outcome [ 28 ]. Interestingly, no influence of geriatric treatment frequency was observed on in-house mortality and after 120 days of follow-up.…”

Section: Discussionsupporting

confidence: 92%

Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

Gleich¹,

Fleischhacker²,

Rascher³

et al. 2021

JCM

View full text Add to dashboard Cite

Interdisciplinary orthogeriatric care of older adult hip fracture patients is of growing importance due to an ageing population, yet there is ongoing disagreement about the most effective model of care. This study aimed to compare different forms of orthogeriatric treatment, with focus on their impact on postoperative mobilization, mobility and secondary fracture prevention. In this observational cohort study, patients aged 70 years and older with a proximal femur fracture requiring surgery, were included from 1 January 2016 to 31 December 2019. Data were recorded from hospital stay to 120-day follow-up in the Registry for Geriatric Trauma (ATR-DGU), a specific designed registry for older adult hip fracture patients. Of 23,828 included patients from 95 different hospitals, 72% were female, median age was 85 (IQR 80–89) years. Increased involvement of geriatricians had a significant impact on mobilization on the first day (OR 1.1, CI 1.1–1.2) and mobility seven days after surgery (OR 1.1, CI 1.1–1.2), initiation of an osteoporosis treatment during in-hospital stay (OR 2.5, CI 2.4–2.7) and of an early complex geriatric rehabilitation treatment (OR 1.3, CI 1.2–1.4). These findings were persistent after 120 days of follow-up. Interdisciplinary treatment of orthogeriatric patients is beneficial and especially during in-patient stay increased involvement of geriatricians is decisive for early mobilization, mobility and initiation of osteoporosis treatment. Standardized treatment pathways in certified geriatric trauma departments with structured data collection in specific registries improve outcome monitoring and interpretation.

show abstract

Section: Discussionsupporting

confidence: 92%

Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

Gleich¹,

Fleischhacker²,

Rascher³

et al. 2021

JCM

View full text Add to dashboard Cite

show abstract

“…Besides the early recognition of coagulopathy and severe shock, early initiated goal-directed transfusion management is crucial [35,36]. In the present study, 30-40% coagulopathic children received blood products independent of age.…”

Section: Discussionmentioning

confidence: 60%

Mechanism, frequency, transfusion and outcome of severe trauma in coagulopathic paediatric patients

Driessen

Wafaisade²,

Lefering³

et al. 2020

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose Acute traumatic coagulopathy can result in uncontrolled haemorrhage responsible for the majority of early deaths after adult trauma. Data on the frequency, transfusion practice and outcome of severe trauma haemorrhage in paediatric patients are inconsistent. Methods Datasets from paediatric trauma patients were retrieved from the registry of the German trauma society (TR-DGU ®) between 2009 and 2016. Coagulopathy was defined by a Quick's value < 70% (INR (international normalized ratio) > 1.4) and/or thrombocytes ≤ 100 k upon emergency room admission. Children were grouped according to age in 4 different groups (A: 1-5, B: 6-10, C: 11-15 and D: 16-17 years). Prevalence of coagulopathy was assessed. Demographics, injury severity, haemostatic management including transfusions and mortality were described. Results 5351 primary admitted children ≤ 17 years with an abbreviated injury scale (AIS) ≥ 3 and complete datasets were included. The prevalence of coagulopathy was 13.7% (733/5351). The majority of the children sustained blunt trauma (more than 90% independent of age group) and a combination of traumatic brain injury (TBI) and any other trauma in more than 60% (A, C, D) and in 53.8% in group B. Coagulopathy occurred the most among the youngest (A: 18.2%), followed by all other age groups with approximately 13%. Overall mortality was the highest in the youngest (A: 40.9%) and among the youngest patients with traumatic brain injury (A: 71.4% and B: 47.1%). Transfusion of packed red blood cells (pRBCs) and fresh frozen plasma (FFPs) occurred almost in a 2:1 ratio (or less) across all age subgroups. Conclusion Traumatic haemorrhage in association with coagulopathy and severe shock is a major challenge in paediatric trauma across all age groups.

show abstract

“…In addition, there is a large diversity in the clinical management of major bleeding events even among advanced trauma centers. 33 There is still a controversy whether the empiric administration of blood products in predefined and fixed ratios (cf. damage control resuscitation [DCR]) might be superior to global coagulation testing in acute setting of trauma to enable goal-directed strategies.…”

Section: Scenario 1: Coagulopathy Following Major Trauma: Goal-direct...mentioning

confidence: 99%

Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

et al. 2022

View full text Add to dashboard Cite

Objectives Detailed and decisive information about the patients' coagulation status is important in various emergency situations. Conventional global coagulation testing strategies are often used to provide a quick overview, but several limitations particularly in the trauma setting are well described. With the introduction of direct oral anticoagulations (DOACs), a milestone for several disease entities resulting in overall improved outcomes could be reached, but at the same time providing new diagnostic challenges for the emergency situation. Design As an alternative to conventional coagulation tests, there is increasing clinical and scientific interest in the use of early whole blood strategies to provide goal-directed coagulation therapies (GDCT) and hemostatic control in critically ill patients. Viscoelastic hemostatic assays (VHAs) were therefore introduced to several clinical applications and may provide as a bedside point-of-care method for faster information on the underlying hemostatic deficiency. Conclusion The use of VHA-based algorithms to guide hemostatic control in emergency situations now found its way to several international guidelines for patients at risk of bleeding. With this qualitative review, we would like to focus on VHA-based GDCT and review the current evidence for its use, advantages, and challenges in the two different clinical scenarios of trauma and intracerebral bleeding/stroke management.

show abstract

Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy

Abstract: This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma-associated coagulopathy amongst international centres. Ongoing work will focus on geographical differences.

Cited by 9 publications

References 36 publications

Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

Increased Geriatric Treatment Frequency Improves Mobility and Secondary Fracture Prevention in Older Adult Hip Fracture Patients—An Observational Cohort Study of 23,828 Patients from the Registry for Geriatric Trauma (ATR-DGU)

Mechanism, frequency, transfusion and outcome of severe trauma in coagulopathic paediatric patients

Global Coagulation Testing in Acute Care Medicine: Back to Bedside?

Contact Info

Product

Resources

About