Acute traumatic coagulopathy：Incidence, risk stratification and therapeutic options

作     者：Marc Maegele 

作者机构：Department of Trauma and Orthopedic Surgery and Institute for Research in Operative Medicine (IFOM) University of Witten/Herdecke Cologne-Merheim Medical Center (CMMC) Ostmerheimerstr. 200 D-51109 Cologne Germany 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2010年第1卷第1期

页      面：12-21页

学科分类：0401[教育学-教育学] 04[教育学] 1002[医学-临床医学] 040110[教育学-教育技术学（可授教育学、理学学位）] 

主　　题：Coagulopathy Epidemiology Management Risk stratification Trauma 

摘      要：BACKGROUND:Uncontrolled hemorrhage is responsible for over 50% of all trauma-related deaths within the first 48 hours after admission. Clinical observations together with recent research resulted in an appreciation of the central role of coagulopathy in acute trauma care. A synopsis is presented of different retrospective analyses based upon datasets from severe multiply injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft fur Unfallchirurgie (DGU)/ German Society of Trauma Surgery) with respect to frequency, risk stratification and therapeutic options of acute traumatic coagulopathy (ATC).;METHODS:The synopsis of different analyses based upon the datasets from severe multiply injured patients derived from the TR-DGU database and development/validation of a scoring system (TASH-score = Trauma Associated Severe Hemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening hemorrhage after severe multiple injuries.;RESULTS:The high frequency of ATC upon emergency room admission is associated with significant morbidity and mortality in multiply 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 hemorrhage at a very early stage after severe multiple injuries.;CONCLUSIONS:An early aggressive management of ATC including a more balanced administration of blood products to improve outcome is advocated.