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

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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.

Results

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 30 min upon patient arrival (49 % <15 min, 48.1 % <30 min). 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.

Conclusions

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.

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Acknowledgments

I would like to thank Rosie Zahn for her advice on the use of English. I also thank Reinhilde Kirchner and Martin Rützler for their cooperation with LimeSurvey. As this study was conducted using an open source survey application there was no need for funding. We, therefore, declare we had no involvement of study sponsors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany

    A. Driessen & M. Maegele

  2. Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany

    V. Albrecht, N. Schäfer, E. K. Stürmer, A. Driessen, L. Betsche, M. Schenk & M. Maegele

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  1. V. Albrecht
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  2. N. Schäfer
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  3. E. K. Stürmer
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  4. A. Driessen
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  5. L. Betsche
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  7. M. Maegele
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Correspondence to V. Albrecht.

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Compliance with ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors; therefore, there was no need for an ethics approval.

Conflict of interest

Verena Albrecht, Nadine Schäfer, Ewa Klara Stürmer, Arne Driessen, Lukas Betsche, Moritz Schenk and Marc Maegele declare that they have no conflict of interest.

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Albrecht, V., Schäfer, N., Stürmer, E.K. et al. Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres. Eur J Trauma Emerg Surg 43, 201–214 (2017). https://doi.org/10.1007/s00068-015-0608-7

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  • DOI: https://doi.org/10.1007/s00068-015-0608-7

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