title: Management of bleeding and coagulopathy following major trauma: an updated European guideline.
abstract: BACKGROUND
  Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.
  
  
  METHODS
  The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.
  
  
  RESULTS
  Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.
  
  
  CONCLUSIONS
  A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.
authors.forename: Donat R
authors.initials: DR
authors.lastname: Spahn
authors.forename: Bertil
authors.initials: B
authors.lastname: Bouillon
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cerny
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Coats
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Mondéjar
authors.forename: Daniela
authors.initials: D
authors.lastname: Filipescu
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Hunt
authors.forename: Radko
authors.initials: R
authors.lastname: Komadina
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nardi
authors.forename: Edmund
authors.initials: E
authors.lastname: Neugebauer
authors.forename: Yves
authors.initials: Y
authors.lastname: Ozier
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.forename: Arthur
authors.initials: A
authors.lastname: Schultz
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D016903:Drug Monitoring / Q000379:methods / Q000592:standards; D005060:Europe / Q000453:epidemiology; D006470:Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000379:methods / Q000592:standards