Frequency, risk stratification and therapeutic management of acute post-traumatic coagulopathy

BACKGROUND: Uncontrolled haemorrhage is still responsible for more than 50% of all trauma-related deaths within the first 48 h after hospital admission. Clinical observations together with recent research resulted in a new appreciation of the central role of coagulopathy in acute trauma care. A synopsis of different analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU)/German Society of Trauma Surgery) with respect to incidence, risk stratification and therapeutic management of acute post-traumatic coagulopathy is presented.

METHODS: Retrospective analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database and development/validation of a scoring system (TASH score = trauma-associated severe haemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening haemorrhage after severe multiple injuries.

RESULTS/CONCLUSION: There is a high frequency of acute post-traumatic coagulopathy already present upon ER admission which is associated with significant morbidity and mortality in multiple-injured patients. The TASH score is recognized as an easy-to-calculate and valid scoring system to predict the individual's probability for massive transfusion and thus ongoing life-threatening haemorrhage at a very early stage after severe multiple injuries. An early aggressive management of acute post-traumatic coagulopathy including a more balanced administration of blood products to favour improved outcome is advocated.