Management of coagulopathy in the patients with multiple injuries: results from an international survey of clinical practice.
BACKGROUND
Bleeding is one of the leading causes of preventable death after traumatic injury. Trauma-associated coagulopathy complicates the control of bleeding. The published approaches on the management of this coagulopathy differ significantly.


METHODS
A qualitative international survey of clinical practice among senior physicians responsible for the treatment of patients with multiple injuries (Injury Severity Score > or = 16) was conducted to document common practices, highlight the variabilities, and profile the rationale behind existing clinical practices around the world.


RESULTS
Survey results are based on 80 (32%) completed returns, representing 25 countries with 93% of respondents employed by trauma centers and a mean of 20 years clinical experience. There are regional differences in the clinical specialty of physicians responsible for trauma management decisions. Blood loss, temperature, pH, platelets, prothrombin time/INR/activated partial thromboplastin time, and overall clinical assessment, were the most common criteria used to assess coagulopathy. Forty-five percent of respondents claimed to follow a massive transfusion protocol in their institution, 19% reported inconsistent protocol use and 34% do not use a protocol. The management of hypothermia, acidosis, blood products, and adjuvant therapy showed regional as well as institutional variability, and surprisingly few massive transfusion protocols specifically address these issues.


CONCLUSIONS
The results of this survey may serve to draw attention to the need for a common definition of coagulopathy and standardized clinical protocols to ensure optimal patient care.
Department of Surgery, University of California, Irvine, Orange, CA 92868, USA. dhoyt@uci.edu
David B
DB
Hoyt
Richard P
RP
Dutton
Carl J
CJ
Hauser
John R
JR
Hess
John B
JB
Holcomb
Yoram
Y
Kluger
Kevin
K
Mackway-Jones
Michael J
MJ
Parr
Sandro B
SB
Rizoli
Tetsuo
T
Yukioka
Bertil
B
Bouillon
D001291:Attitude of Health Personnel; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D001803:Blood Transfusion / Q000379:methods* / Q000706:statistics & numerical data; D002983:Clinical Competence; D042241:Early Diagnosis; D004638:Emergency Treatment / Q000592:standards / Q000639:trends; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D007391:International Cooperation; D008297:Male; D009104:Multiple Trauma / Q000150:complications* / Q000175:diagnosis; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D065227:Transfusion Reaction; D014193:Trauma Centers; D016896:Treatment Outcome; D014481:United States