title: Practice management of acute trauma haemorrhage and haemostatic disorders across German trauma centres.
abstract: OBJECTIVE
  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.
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany. verena.albrecht@uni-wh.de.
authors.forename: V
authors.initials: V
authors.lastname: Albrecht
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Schäfer
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: E K
authors.initials: EK
authors.lastname: Stürmer
authors.affiliation: 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.|Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Driessen
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Betsche
authors.affiliation: Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schenk
authors.affiliation: 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.|Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Campus Cologne-Merheim, Ostmerheimer Str. 200, House 38, 51109, Cologne, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Maegele
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000628:therapy*; D001803:Blood Transfusion; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006470:Hemorrhage / Q000175:diagnosis / Q000628:therapy*; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; 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
keywords: Coagulopathy; Management; NOACs; Survey; Trauma haemorrhage; Treatment algorithm