Management of internal bleeding : Guidelines of the American Association for the Surgery of Trauma (AAST) and World Society of Emergency Surgery (WSES)

Abstract

Internal bleeding is a common and serious complication in trauma patients. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) have developed comprehensive guidelines to standardize and optimize the care of these patients. In Germany, abdominal injuries are involved in around 20% of all polytraumas, often caused by falls or road traffic accidents. The liver and spleen are most frequently affected. Correct diagnosis and timely management are crucial for patient survival. Computed tomography (CT) is gold standard to assess organ injuries, while ultrasound (fokussiertes Assessment mit Sonographie für Trauma, FAST) provides a readily available, non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is used for detailed soft tissue injuries. The AAST has developed a scoring system (Organ Injury Scale, OIS) to classify the severity of organ injuries. The WSES classifies the hemodynamic condition of the patient. Spleen: Treatment decisions are based on hemodynamic stability. Unstable patients often require emergency surgery, while stable patients can be treated conservatively. In the presence of active bleeding, embolization is a treatment option. Liver: Stable patients with a positive blush (leakage of contrast medium) are treated angiographically. Unstable patients should undergo surgery with perihepatic packing and Pringle maneuver. Kidney: Conservative treatment for stable patients. Embolization is used for active bleeding. Unstable patients require surgical treatment. Gastrointestinal tract: Duodenal hematomas can be treated conservatively. Pancreatic injuries require conservative or surgical intervention depending on the severity and stability of the patient. These guidelines aim to improve the survival and outcome of trauma patients with internal bleeding.