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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ.

Methods

To assess local differences in infrastructure, logistics and clinical management of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25–27 May 2014.

Results

446/1,540 delegates completed the questionnaire yielding a response rate of 29 %. The majority specified to work as consultants/senior physicians (47.3 %) in general (36.1 %) or trauma/orthopaedic surgery (44.5 %) of level I (70 %) or level II (19 %) trauma centres. Clinical assessment (>80 %) and standard coagulation assays (74.6 %) are the most frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30 % of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69 %) have implemented local protocols based on international and national guidelines using conventional blood products, e.g. packed red blood cell concentrates (93.3 %), fresh frozen plasma concentrates (93.3 %) and platelet concentrates (83 %), and antifibrinolytics (100 %). 89 % considered the continuous intake of anticoagulants including “new oral anticoagulants” and platelet inhibitors as an increasing threat to bleeding trauma patients.

Conclusions

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.

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Acknowledgments

The research presented has been conducted in context with the Seventh Framework Programme under grant agreement no: 602771, 2013-07-11 (TACTIC: “Targeted Action for Curing Trauma Induced Coagulopathy”), which receives funding from the EU. The collaborator names of the TACTIC partners are: Pär Johansson, Sisse Rye Ostrowski, Hannele Tuovinen, Jakob Stensballe, Johann Carel Goslings, Nicole Juffermans, Kirsten Balvers, Christine Gaarder, Karim Brohi, Simon Eaglestone, Claire Rourke, Helen Campbell, Nicola Curry, Simon Stanworth, Marc Maegele, Ewa K. Stürmer, Nadine Schäfer, Arne Driessen, Adrian Orr, and Axel Schubert.

We would like to thank Theresa Aldorf, Lara Genz, Johanna Tegtmeyer, Jasmin Ofir, Conrad Wiegand, Nicolas Wewel, Julian-Dario Rembe and Lukas Betsche for supporting this survey during the conference. Lastly, our special thanks go to 2014 ECTES and WTC congress president, Professor Dr. Ingo Marzi and his staff (Frankfurt/Germany) for generously supporting our endeavour. None of the authors or the group received fees for this endeavour.

Exclusively for this survey we accepted financial support from CSL Behring (Marburg/Germany) to cover costs for transport, accommodation and rent of the electronic equipment.

The research leading to these results has received funding from the European Commission under the FP7-HEALTH-Contract No. F3-2013-602771.

Conflict of interest

Arne Driessen, Nadine Schäfer, Verena Albrecht, Moritz Schenk, Matthias Fröhlich, Ewa Klara Stürmer, Marc Maegele and TACTIC partner declare that they have no conflict of interest.

Ethical standard

This article does not contain any studies with human participants or animals performed by any of the authors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr 200, 51109, Cologne, Germany

    A. Driessen, M. Fröhlich & M. Maegele

  2. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr. 200, 51109, Cologne, Germany

    A. Driessen, N. Schäfer, V. Albrecht, M. Schenk, E. K. Stürmer & M. Maegele

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  1. A. Driessen
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Correspondence to A. Driessen.

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TACTIC partners: Pär Johansson, Sisse Rye Ostrowski, Hannele Tuovinen, Jakob Stensballe, Johann Carel Goslings, Nicole Juffermans, Kirsten Balvers, Christine Gaarder, Karim Brohi, Simon Eaglestone, Claire Rourke, Helen Campbell, Nicola Curry, Simon Stanworth, Marc Maegele, Ewa K. Stürmer, Nadine Schäfer, Arne Driessen, Adrian Orr, and Axel Schubert.

A. Driessen and N. Schäfer authors contributed equally to this work.

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Supplementary material 1 (DOC 33 kb). Figure 1 supplement Overview of the web-based questionnaire

68_2014_455_MOESM2_ESM.doc

Supplementary material 2 (DOC 126 kb). Table 1 supplement Overview of respondents to the questionnaire and delegates to the congress

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Driessen, A., Schäfer, N., Albrecht, V. et al. Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy. Eur J Trauma Emerg Surg 41, 413–420 (2015). https://doi.org/10.1007/s00068-014-0455-y

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