Trauma and hemorrhage control: a systematic review

Abstract

Worldwide, trauma is a leading cause of death and disability. Hemorrhage is responsible for up to 40% of trauma deaths. Recent strategies to improve mortality rates have focused on optimal methods of early hemorrhage control and correction of coagulopathy. This review aimed to evaluate hemorrhage control in trauma patients and to assess the effectiveness of interventions in bleeding and/or transfusion requirements; correction of trauma-induced coagulopathy and mortality. The Google Scholar, Web of Science, Cochrane, and PubMed databases were used to explore studies between 2012 and 2023. The keywords included "hemorrhage, control, trauma, patients, bleeding, coagulopathy, and mortality" and were used in various combinations. In addition, original research reporting hemorrhage control in trauma patients was evaluated. Full-text publications served as the inclusion criterion. Though 85 articles were obtained, only eight met the inclusion criteria. All the studies were retrospective. The study population was comprised of more than 9,634 trauma patients. Uncontrolled hemorrhagic shock was found to be the main reason for trauma patients' death. The resuscitation strategy should center upon permissive hypotension and early hemostatic resuscitation combined to identify and correct coagulopathy. Antiplatelet therapy patients with ground-level falls had a higher risk of traumatic intracranial hemorrhage than anticoagulation therapy patients. For patients suffering hemorrhagic shock, and especially from truncal hemorrhage, the recommended primary outcome was 3 to 6-hour all-cause mortality, chosen to coincide with the physiology of hemorrhagic death and to avoid bias from competing risks. For pelvic trauma patients, intervention for pelvic hemorrhage management was necessary.