Focus issue European Journal of Trauma and Emergency Surgery on “Volume Resuscitation and Coagulation”

Excerpt

This focus issue of the European Journal of Trauma and Emergency Surgery compiles another great collection of outstanding clinical research in the field of trauma “Volume Resuscitation and Coagulation”. The selected topic is of utmost clinical relevance as uncontrolled bleeding together with trauma-induced haemostatic failure is still considered as the major cause of preventable death after severe injury and rapid diagnosis and action is required as most of the patients die early within the first 6 h of impact. Furthermore, timely correction of haemostatic disturbances after trauma has been associated with improved overall outcome related to both mortality and morbidity. In this issue of the European Journal of Trauma and Emergency Surgery, Brilej and co-workers, identified another set of clinical indicators for early risk stratification in bleeding trauma patients with potential haemostatic failure prone to receive further viscoelastic testing and “goal-directed” coagulation therapies [1]. Their retrospective study was based upon data from almost 500 severely injured trauma patients treated in their local trauma center which had been entered into the German TraumaRegistry DGU^® database. The trauma cohort investigated confirmed the clinical impact of critical bleeding among severely injured trauma patients as more than half of the patients presented with haemostatic abnormalities to the trauma bay. The prediction model suggested by the authors includes severe injuries to the torso and limbs, infusion of >1000 mls of fluids during the pre-hospital phase of care and hypotension <90 mmHg which yielded a sensitivity to predict coagulopathy of 93% if all three criteria were met. Adding Base Excess (BE) ≤−5 obtained from rapid ABGs increased the specificity of the model to 81.7%. While the criteria for the activation of coagulation support remain clearly center dependent, in the given setting the suggested model could serve adequately to initiate further viscoelastic testing followed by improved therapies. This single-center experience, of course, needs broader confirmation and prospective validation. …