Transfusion Approaches and Mortality in Trauma Patients: A Narrative Review

Fries, Dietmar; Innerhofer, Petra; Spahn, Donat R.

doi:10.1055/s-0037-1605570

Cited by 5 publications

(1 citation statement)

References 55 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The organ salvage rate ranges from 86 to 100%, with success rates > 90% in splenic injuries and between 79% and 92% in liver injuries by using arterial embolization [34–36]. Even if morbidity and complication rates like re-bleeding should be considered after angiography [9], further improvements in overall mortality by increased implementation of these techniques and modern coagulation management could be expected in our center [37, 38].…”

Section: Discussionmentioning

confidence: 99%

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

et al. 2019

View full text Add to dashboard Cite

Background A widespread shift to non-operative management (NOM) for blunt hepatic and splenic injuries has been observed in most centers worldwide. Furthermore, many countries introduced safety measures to systematically reduce severe traffic and leisure sports injuries. This study aims to evaluate the effect of these nationwide implementations on individual patient characteristics and outcomes through a time-trend analysis over 17 years in an Austrian high-volume trauma center. Methods A retrospective review of all emergency trauma patients admitted to the Medical University of Innsbruck from 2000 to 2016. Injury severity, clinical data on admission, operative and non-operative treatment parameters, complications, and in-hospital mortality were evaluated. Results In total, 731 patients were treated with blunt hepatic and/or splenic injuries. Among these, 368 had a liver injury, 280 splenic injury, and 83 combined hepatic/splenic injury. Initial NOM was performed in 82.6% of all patients (93.5% in hepatic and 71.8% in splenic injuries) with a success rate of 96.7%. The secondary failure rate of NOM was 3.3% and remained consistent over 17 years ( p = 0.515). In terms of injury severity, we observed a reduction over time, resulting in an overall mortality rate of 4.8% and 3.5% in the NOM group (decreasing from 7.5 to 1.9% and from 5.6 to 1.3%, respectively). These outcomes confirmed an improved utilization of the NOM approach. Conclusion Our cohort represents one of the largest Central European single-center experiences available in the literature. NOM is the standard of care for blunt hepatic and splenic injuries and successful in > 96% of all patients. This rate was quite constant over 17 years ( p = 0.515). Overall, national and regional safety measures resulted in a significantly decreased severity of observed injury patterns and deaths due to blunt hepatic or splenic trauma. Although surgery is nowadays only applied in about one third of splenic injury patients in our center, these numbers might further decrease by intensified application of interventional radiology and modern coagulation management. Electronic supplementary material The online version of this article (10.1186/s13017-019-0249-y) contains supplementary material, which is available to authorized users.

show abstract

Section: Discussionmentioning

confidence: 99%

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

et al. 2019

View full text Add to dashboard Cite

show abstract

Thrombosis and Hemostasis in Surgery

Hvas

Larsen

Pasalic

2017

Semin Thromb Hemost

View full text Add to dashboard Cite

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Görlinger¹,

Pérez-Ferrer

Dirkmann

et al. 2023

Gematologiâ i transfuziologiâ

View full text Add to dashboard Cite

Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic method and enables to assess viscoelastic profiles of whole blood in various clinical settings. ROTEM-guided bleeding management has become an essential part of patient blood management (PBM) which is an important concept in improving patient safety. Here, ROTEM testing and hemostatic interventions should be linked by evidence-based, setting-specific algorithms adapted to the specific patient population of the hospitals and the local availability of hemostatic interventions. Accordingly, ROTEM-guided algorithms implement the concept of personalized or precision medicine in perioperative bleeding management (“theranostic” approach). ROTEM-guided PBM has been shown to be effective in reducing bleeding, transfusion requirements, complication rates, and health care costs. Accordingly, several randomized-controlled trials, meta-analyses, and health technology assessments provided evidence that using ROTEM-guided algorithms in bleeding patients resulted in improved patient’s safety and outcomes including perioperative morbidity and mortality. However, the implementation of ROTEM in the PBM concept requires adequate technical and interpretation training, education and logistics, as well as interdisciplinary communication and collaboration.

show abstract

Transfusion Approaches and Mortality in Trauma Patients: A Narrative Review

Cited by 5 publications

References 55 publications

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

Non-operative management of blunt hepatic and splenic injury: a time-trend and outcome analysis over a period of 17 years

Thrombosis and Hemostasis in Surgery

The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management

Contact Info

Product

Resources

About