Article Text

PDF
Trauma-induced coagulopathy in severely injured patients: knowledge lost in translation?
  1. Victor Jeger,
  2. Natalie Urwyler,
  3. Heinz Zimmermann,
  4. Aristomenis K Exadaktylos
  1. Department of Anesthesia, Inselspital, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Aristomenis K Exadaktylos, Department of Emergency Medicine, Division of Anaesthesia, Intensive Care and Emergency Medicine, Inselspital Bern, University Hospital, Bern 3008, Switzerland; aristomenis{at}exadaktylos.ch

Abstract

Background Many guidelines exist on how to treat patients with multiple injuries correctly in an accident and emergency setting. The aim of the present work was to find out how well patients are treated focusing on trauma induced coagulopathy (TIC), and what anaesthetists involved in trauma care think about their own experiences with TIC.

Methods In a retrospective chart review of patients with an Injury Severity Score (ISS)≥16 between October 2007 and October 2008. A total of 172 patients with multiple injuries (134 men, 38 women) were treated in the resuscitation room and underwent complete coagulation screening (international normalised ratio (INR), activated partial thromboplastin time (aPTT), thrombin time (TT)). The presence of TIC was defined as INR>1.5 and aPTT>60 s or TT>15 s. Additionally, during the weekly anaesthesia and critical care grand round, a short questionnaire about TIC management was distributed to all anaesthetists involved in trauma care.

Results Of the 172 patients with multiple injuries, 56 (32.6%) had TIC at admission to the resuscitation bay and 7 of these 56 (12.5%) received fresh-frozen plasma in the first hour of treatment. The mean of 55 anaesthetists thought that TIC could be corrected within about 30 min, although a chart review shows that it takes about 60 min to get complete laboratory based coagulation screening results. However, 70% of the doctors are not satisfied with the laboratory results they receive concerning TIC.

Conclusions There is an obvious discrepancy between the content of guidelines and the everyday practice. Future academic efforts in the area of trauma care should therefore focus more on the translational approach and the implementation of existing knowledge rather than on simply formulating guidelines.

  • Guidelines
  • trauma care
  • trauma induced coagulopathy
  • trauma, major trauma management

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.