title: Infrastructure and clinical practice for the detection and management of trauma-associated haemorrhage and coagulopathy.
abstract: OBJECTIVE
  Early detection and management of post-traumatic haemorrhage and coagulopathy have been associated with improved outcomes, but local infrastructures, logistics and clinical strategies may differ.
  
  
  METHODS
  To assess local differences in infrastructure, logistics and clinical management of trauma-associated haemorrhage and coagulopathy, we have conducted a web-based survey amongst the delegates to the 15th European Congress of Trauma and Emergency Surgery (ECTES) and the 2nd World Trauma (WT) Congress held in Frankfurt, Germany, 25-27 May 2014.
  
  
  RESULTS
  446/1,540 delegates completed the questionnaire yielding a response rate of 29%. The majority specified to work as consultants/senior physicians (47.3%) in general (36.1%) or trauma/orthopaedic surgery (44.5%) of level I (70%) or level II (19%) trauma centres. Clinical assessment (>80%) and standard coagulation assays (74.6%) are the most frequently used strategies for early detection and monitoring of bleeding trauma patients with coagulopathy. Only 30% of the respondents declared to use extended coagulation assays to better characterise the bleeding and coagulopathy prompted by more individualised treatment concepts. Most trauma centres (69%) have implemented local protocols based on international and national guidelines using conventional blood products, e.g. packed red blood cell concentrates (93.3%), fresh frozen plasma concentrates (93.3%) and platelet concentrates (83%), and antifibrinolytics (100%). 89% considered the continuous intake of anticoagulants including "new oral anticoagulants" and platelet inhibitors as an increasing threat to bleeding trauma patients.
  
  
  CONCLUSIONS
  This study confirms differences in infrastructure, logistics and clinical practice for the detection and management of trauma-haemorrhage and trauma-associated coagulopathy amongst international centres. Ongoing work will focus on geographical differences.
authors.affiliation: Department of Orthopaedic Surgery, Traumatology and Sports Traumatology, Cologne-Merheim Medical Centre (CMMC), Witten/Herdecke University (Campus Cologne-Merheim), Ostmerheimerstr 200, 51109, Cologne, Germany, driessena@kliniken-koeln.de.
authors.forename: A
authors.initials: A
authors.lastname: Driessen
authors.forename: N
authors.initials: N
authors.lastname: Schäfer
authors.forename: V
authors.initials: V
authors.lastname: Albrecht
authors.forename: M
authors.initials: M
authors.lastname: Schenk
authors.forename: M
authors.initials: M
authors.lastname: Fröhlich
authors.forename: E K
authors.initials: EK
authors.lastname: Stürmer
authors.forename: M
authors.initials: M
authors.lastname: Maegele
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D016913:Blood Component Transfusion / Q000379:methods; D019468:Disease Management; D004630:Emergencies; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006470:Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
chemical_list: D000925:Anticoagulants; D006490:Hemostatics