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Trauma coagulopathy

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https://www.readbyqxmd.com/read/28639537/prehospital-identification-of-trauma-patients-requiring-transfusion-results-of-a-retrospective-study-evaluating-the-use-of-the-trauma-induced-coagulopathy-clinical-score-ticcs-in-33-385-patients-from-the-traumaregister-dgu-%C3%A2
#1
Martin Tonglet, Rolf Lefering, Jean Marc Minon, Alexandre Ghuysen, Vincenzo D'Orio, Frank Hildebrand, Hans-Christoph Pape, Klemens Horst
BACKGROUND: Identifying trauma patients that need emergent blood product transfusion is crucial. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure score developed to meet this medical need. We hypothesized that TICCS would assist in identifying patients that need a transfusion in a large cohort of severe trauma patients from the TraumaRegister DGU(®) (TR-DGU). MATERIALS AND METHODS: A total of 33,385 severe trauma patients were extracted from the TR-DGU for retrospective analysis...
June 22, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28637514/performance-of-point-of-care-international-normalized-ratio-measurement-to-diagnose-trauma-induced-coagulopathy
#2
Thomas Mistral, Yvonnick Boué, Jean-Luc Bosson, Pauline Manhes, Jules Greze, Julien Brun, Pierre Albaladejo, Jean-François Payen, Pierre Bouzat
BACKGROUND: Trauma-induced coagulopathy (TIC) is a common feature after severe trauma. Detection of TIC is based upon classic coagulation tests including international normalized ratio (INR) value. Point-of-care (POC) devices have been developed to rapidly measure INR at the bedside on whole blood. The aim of the study was to test the precision of the Coagucheck® XS Pro device for INR measurement at hospital admission after severe trauma. METHODS: We conducted a prospective observational study in a French level I trauma center...
June 21, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28632435/relative-effects-of-plasma-fibrinogen-concentrate-and-factor-xiii-on-rotem-coagulation-profiles-in-an-in-vitro-model-of-massive-transfusion-in-trauma
#3
David E Schmidt, Märit Halmin, Agneta Wikman, Anders Östlund, Anna Ågren
Massive traumatic haemorrhage is aggravated through the development of trauma-induced coagulopathy, which is managed by plasma transfusion and/or fibrinogen concentrate administration. It is yet unclear whether these treatments are equally potent in ensuring adequate haemostasis, and whether additional factor XIII (FXIII) administration provides further benefits. In this study, we compared ROTEM whole blood coagulation profiles after experimental massive transfusion with different transfusion regimens in an in vitro model of dilution- and transfusion-related coagulopathy...
June 20, 2017: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/28624047/viscoelastic-monitoring-in-pediatric-trauma-a-survey-of-pediatric-trauma-society-members
#4
Robert T Russell, Ilan I Maizlin, Adam M Vogel
BACKGROUND: Viscoelastic monitoring (VEM), including thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in the setting of goal-directed hemostatic resuscitation has been shown to improve outcomes in adult trauma. The American College of Surgeons (ACS) Committee on Trauma recommends that "thromboelastography should be available at level I and level II trauma centers". The purpose of this study is to determine the current availability and utilization of VEM in pediatric trauma...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28612932/prehospital-parameters-can-help-to-predict-coagulopathy-and-massive-transfusion-in-trauma-patients
#5
J-S David, E-J Voiglio, E Cesareo, O Vassal, E Decullier, P-Y Gueugniaud, S Peyrefitte, K Tazarourte
BACKGROUND: This study aimed to evaluate the accuracy of prehospital parameters, including vital signs and resuscitation (fluids, vasopressor), to predict trauma-induced coagulopathy (TIC, fibrinogen <1·5 g/l or PTratio > 1·5 or platelet count <100 × 10(9) /l), and a massive transfusion (MT, ≥10 RBC units within the first 24 h). METHODS: From a trauma registry (2011-2015), in which patients are prospectively included, we retrospectively retrieved the heart rate (HR), systolic blood pressure (SBP), volume of prehospital fluids and administration of noradrenaline...
June 14, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28601310/hemoglobin-based-oxygen-carriers-promote-systemic-hyperfibrinolysis-that-is-both-dependent-and-independent-of-plasmin
#6
Alexander P Morton, Ernest E Moore, Hunter B Moore, Eduardo Gonzalez, Michael P Chapman, Erik Peltz, Anirban Banerjee, Christopher Silliman
BACKGROUND: Hyperfibrinolysis plays an integral role in the genesis of trauma-induced coagulopathy. Recent data demonstrate that red blood cell lysis promotes fibrinolysis; however, the mechanism is unclear. Hemoglobin-based oxygen carriers (HBOCs) have been developed for resuscitation and have been associated with coagulopathy. We hypothesize that replacement of whole blood (WB) using an HBOC results in a coagulopathy because of the presence of free hemoglobin. MATERIALS AND METHODS: WB was sampled from healthy donors (n = 6)...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28584429/thromboelastography-for-evaluation-of-coagulopathy-in-nonbleeding-patients-with-sepsis-at-intensive-care-unit-admission
#7
Syed Nabeel Muzaffar, Arvind Kumar Baronia, Afzal Azim, Anupam Verma, Mohan Gurjar, Banani Poddar, Ratender Kumar Singh
BACKGROUND: Thromboelastography (TEG) is a global test of coagulation which analyzes the whole coagulation process. TEG is popular in trauma, liver transplant, and cardiac surgeries, but studies in sepsis are limited. We have assessed the utility of TEG for evaluating coagulopathy in nonbleeding patients with sepsis. MATERIALS AND METHODS: A prospective, observational study was done in 12-bedded Intensive Care Unit (ICU) of a tertiary care hospital in North India, during May 2014-November 2014...
May 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28583756/thrombelastography-indicates-limitations-of-animal-models-of-trauma-induced-coagulopathy
#8
Gregory R Stettler, Ernest E Moore, Hunter B Moore, Peter J Lawson, Miguel Fragoso, Geoffrey R Nunns, Christopher C Silliman, Anirban Banerjee
BACKGROUND: Thrombelastography (TEG) has been used to characterize the coagulation changes associated with injury and shock. Animal models developed to investigate trauma-induced coagulopathy (TIC) have failed to produce excessive bleeding. We hypothesize that a native TEG will demonstrate marked differences in humans compared with these experimental models, which explains the difficulties in reproducing a clinically relevant coagulopathy in animal models. METHODS: Whole blood was collected from 138 healthy human volunteers, 25 swine and 66 Sprague-Dawley rats before experimentation...
May 11, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28578713/delayed-onset-haematoma-formation-after-cochlear-implantation
#9
W-K Low, S Xu
OBJECTIVE: This paper presents our experience on delayed-onset haematoma formation after cochlear implantation, a topic which has not been well discussed in the literature. METHOD: Retrospective case review study. RESULTS: Five children who had undergone cochlear implant surgery at 1.5 to 4 years of age (median, 2.5 years) were studied. The haematoma episodes occurred 2-12 years (median, 6 years) after cochlear implantation. Two patients had recurrent episodes...
June 5, 2017: Journal of Laryngology and Otology
https://www.readbyqxmd.com/read/28574329/spinal-epidural-hematomas-personal-experience-and-literature-review-of-more-than-1000-cases
#10
Maurizio Domenicucci, Cristina Mancarella, Giorgio Santoro, Demo Eugenio Dugoni, Alessandro Ramieri, Maria Felice Arezzo, Paolo Missori
OBJECTIVE The goal of this study was to identify factors that contribute to the formation of acute spinal epidural hematoma (SEH) by correlating etiology, age, site, clinical status, and treatment with immediate results and long-term outcomes. METHODS The authors reviewed their series of 15 patients who had been treated for SEH between 1996 and 2012. In addition, the authors reviewed the relevant international literature from 1869 (when SEH was first described) to 2012, collecting a total of 1010 cases. Statistical analysis was performed in 959 (95%) cases that were considered valid for assessing the incidence of age, sex, site, and clinical status at admission, correlating each of these parameters with the treatment results...
June 2, 2017: Journal of Neurosurgery. Spine
https://www.readbyqxmd.com/read/28570309/admission-rapid-thrombelastography-rteg%C3%A2-values-predict-resuscitation-volumes-and-patient-outcomes-after-thermal-injury
#11
Todd F Huzar, Eric Martinez, Joseph Love, Tonya C George, Jaimin Shah, Lisa Baer, James M Cross, Charles E Wade, Bryan A Cotton
In trauma, admission rapid thrombelastography (rTEG) has been shown to predict in-hospital thromboembolic events, guide treatment of coagulopathy, and identify likely to require large volume resuscitations. We sought to evaluate the use of rTEG in describing the coagulation status of major burn patients at admission and assess whether rTEG values predicted resuscitation volumes and patient outcomes. This is a retrospective study of all patients admitted to our Burn ICU between January 2010 and December 2012...
May 26, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/28554592/progresses-in-understanding-trauma-induced-coagulopathy-and-the-underlying-mechanism
#12
REVIEW
Na Peng, Lei Su
Trauma-induced coagulopathy (TIC) is a clinical syndrome caused by imbalance between clotting, anti-coagulation and fibrinolysis resulting from multiple pathological factors such as hemorrhage and tissue injury in the early stage of trauma, and is closely related to the outcome of trauma patients. It is proved in growing evidence that the endogenous coagulation disturbance in trauma itself is the activating factor of TIC, rather than dilution or other acquired coagulopathy. Therefore, a thorough understanding of the molecular mechanisms in the pathogenesis and progression is crucial for effective prevention and treatment in patients with TIC...
May 10, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28552329/updated-concepts-on-the-pathophysiology-and-the-clinical-management-of-trauma-hemorrhage-and-coagulopathy
#13
REVIEW
Marc Maegele, Zheng-Tao Gu, Qiao-Bing Huang, Hong Yang
Uncontrolled hemorrhage and subsequent trauma-induced coagulopathy (TIC) are still the principle causes for preventable death after trauma and early detection and aggressive management have been associated with reduced mortality. Despite increasing knowledge about trauma resuscitation, best practice to treat this newly defined entity is still under debate. A synopsis of best current knowledge with reference to the updated European trauma guideline on the management of severe trauma hemorrhage and TIC is presented...
May 17, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/28547532/prehospital-blood-transfusions-in-pediatric-trauma-and-nontrauma-patients-a-single-center-review-of-safety-and-outcomes
#14
Aodhnait S Fahy, Cornelius A Thiels, Stephanie F Polites, Maile Parker, Michael B Ishitani, Christopher R Moir, Kathleen Berns, James R Stubbs, Donald H Jenkins, Scott P Zietlow, Martin D Zielinski
PURPOSE: Prehospital transfusions are a novel yet increasingly accepted intervention in the adult population as part of remote damage control resuscitation, but prehospital transfusions remain controversial in children. Our purpose was to review our pediatric prehospital transfusion experience over 12 years to describe the safety of prehospital transfusion in appropriately triaged trauma and nontrauma patients. METHODS: Children (<18 years) transfused with packed red blood cells (pRBC) or plasma during transport to a single regional academic medical center between 2002 and 2014 were identified...
May 25, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28542848/change-of-transfusion-and-treatment-paradigm-in-major-trauma-patients
#15
P Stein, A Kaserer, K Sprengel, G A Wanner, B Seifert, O M Theusinger, D R Spahn
Trauma promotes trauma-induced coagulopathy, which requires urgent treatment with fixed-ratio transfusions of red blood cells, fresh frozen plasma and platelet concentrates, or goal-directed administration of coagulation factors based on viscoelastic testing. This retrospective observational study compared two time periods before (2005-2007) and after (2012-2014) the implementation of changes in trauma management protocols which included: use of goal-directed coagulation management; admission of patients to designated trauma centres; whole-body computed tomography scanning on admission; damage control surgery; permissive hypotension; restrictive fluid resuscitation; and administration of tranexamic acid...
May 23, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28538641/prehospital-plasma-resuscitation-associated-with-improved-neurologic-outcomes-after-traumatic-brain-injury
#16
Matthew C Hernandez, Cornelius A Thiels, Johnathon M Aho, Elizabeth B Habermann, Martin D Zielinski, James A Stubbs, Donald H Jenkins, Scott P Zietlow
INTRODUCTION: Trauma related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBI). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improve neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all poly-trauma patients age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single level I trauma center from 01/2002 to 12/2013...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28529911/severe-trauma-in-the-geriatric-population
#17
REVIEW
Juan Antonio Llompart-Pou, Jon Pérez-Bárcena, Mario Chico-Fernández, Marcelino Sánchez-Casado, Joan Maria Raurich
Geriatric trauma constitutes an increasingly recognized problem. Aging results in a progressive decline in cellular function which leads to a loose of their capacity to respond to injury. Some medications commonly used in this population can mask or blunt the response to injury. Falls constitute the most common cause of trauma and the leading cause of trauma-related deaths in this population. Falls are complicated by the widespread use of antiplatelets and anticoagulants, especially in patients with brain injury...
May 4, 2017: World Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28522144/viscoelastic-tissue-plasminogen-activator-challenge-predicts-massive-transfusion-in-15-minutes
#18
Hunter B Moore, Ernest E Moore, Michael P Chapman, Benjamin R Huebner, Peter M Einersen, Solimon Oushy, Christopher C Silliman, Anirban Banerjee, Angela Sauaia
BACKGROUND: Coagulopathy is associated with massive transfusion in trauma, yet most clinical scores to predict this end point do not incorporate coagulation assays. Previous work has identified that shock increases circulating tissue plasminogen activator (tPA). When tPA levels saturate endogenous inhibitors, systemic hyperfibrinolysis can occur. Therefore, the addition of tPA to a patient's blood sample could stratify a patients underlying degree of shock and early coagulation changes to predict progression to massive transfusion...
April 17, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28509781/correction-of-severe-coagulopathy-and-hyperfibrinolysis-by-tranexamic-acid-and-recombinant-factor-viia-in-a-cirrhotic-patient-after-trauma-a-case-report
#19
Jack Louro, Katherine Andersen, Roman Dudaryk
Coagulopathy induced by trauma or cirrhosis is a well-recognized entity. Viscoelastic testing has been used in either condition for goal-directed transfusion and detection of fibrinolysis since conventional coagulation tests do not correlate with clinical risk of bleeding. Hemostatic resuscitation may not be adequate for a trauma patient with liver disease due to complex alterations in coagulation systems and occasionally require adjuvant therapy. We report a case of trauma-induced coagulopathy presenting as severe hyperfibrinolysis in a cirrhotic patient who was refractory to hemostatic resuscitation but was rapidly corrected by the administration of tranexamic acid and recombinant Factor VIIa...
May 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28509684/histone-complexed-dna-fragments-levels-are-associated-with-coagulopathy-endothelial-cell-damage-and-increased-mortality-after-severe-pediatric-trauma
#20
Robert T Russell, Sarah C Christiaans, Tate Nice, Morgan Banks, Vincent Mortellaro, Charity Morgan, Amy Duhachek-Stapelman, Steven J Lisco, Jeffrey D Kerby, Brant M Wagener, Mike K Chen, Jean-François Pittet
BACKGROUND: The release of damage-associated molecular pattern molecules (DAMPs) in the extracellular space secondary to injury has been shown to cause systemic activation of the coagulation system and endothelial cell damage. We hypothesized that pediatric trauma patients with increased levels of histone-complexed DNA fragments (hcDNA) would have evidence of coagulopathy and endothelial damage that would be associated with poor outcomes. METHODS: We conducted a prospective observational study of 149 pediatric trauma patients and 62 control patients at two level 1 pediatric trauma centers from 2013-2016...
May 15, 2017: Shock
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