Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres.

Abstract

Early detection and management of trauma haemorrhage and coagulopathy have been associated with improved outcomes. We assessed infrastructure, logistics and management practice of trauma-associated haemorrhage and coagulopathy across German trauma centres. A web-based survey of 20 questions was developed using the open source survey application LimeSurvey®. It was disseminated among surgeons and anaesthetists in Germany. 145 Questionnaires were returned of which 106 were completed and analysed. Two-thirds of the respondents declared they worked in level I trauma centres. Only 61% followed a treatment algorithm. Over 90% used standard laboratory and coagulation tests for decision-making. 56.6% declared they additionally used extended coagulation assays (TEG/ROTEM). Packed red blood cells, fresh frozen plasma, platelet concentrates, prothrombin complex concentrates, tranexamic acid, calcium, fibrinogen and vitamin K were used by more than 85% of the respondents for the initial treatment. In all hospitals, irrespective of care level, the first blood product was administered in less than 30min upon patient arrival (49%<15min, 48.1%<30min). New oral anticoagulants (NOACs) were identified as an increasing problem in today`s trauma care (>95%) and 65% of the respondents necessitated reliable tests for early risk stratification. 57.6% necessitated interdisciplinary training programs to improve clinical skills. There is variation in the local infrastructure, logistics and management of trauma haemorrhage and coagulopathy across German trauma centres. More than one-third of the respondents declare they do not consistently follow a treatment algorithm. NOACs are considered as an increasing problem in acute trauma care.