Management of coagulopathy in the patients with multiple injuries: results from an international survey of clinical practice.
J Trauma
; 65(4): 755-64; discussion 764-5, 2008 Oct.
Article
em En
| MEDLINE
| ID: mdl-18849787
ABSTRACT
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transtornos da Coagulação Sanguínea
/
Transfusão de Sangue
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Traumatismo Múltiplo
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Avaliação de Resultados em Cuidados de Saúde
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Mortalidade Hospitalar
Tipo de estudo:
Diagnostic_studies
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Etiology_studies
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Guideline
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Prognostic_studies
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Qualitative_research
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Risk_factors_studies
/
Screening_studies
Limite:
Female
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Humans
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Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2008
Tipo de documento:
Article