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HEM-18: VARIATIONS IN INFRASTRUCTURE, LOGISTICS AND CLINICAL PRACTICE FOR THE DETECTION AND MANAGEMENT OF TRAUMA ASSOCIATED HAEMORRHAGE AND COAGULOPATHY ACROSS TRAUMA CENTRES IN GERMANY.

Shock 2015 October
INTRODUCTION: Early detection of trauma haemorrhage and coagulopathy has been associated with improved outcomes. We assessed infrastructure, logistics and management of trauma haemorrhage and coagulopathy across German trauma centres.

METHODS: An online-survey (20 questions) was developed and analysed using the open source survey application LimeSurvey®. It was disseminated among surgeons and anaesthetists in Germany. Hospitals of all levels were addressed.

RESULTS: 106 questionnaires were completed and analysed. Two thirds declared they worked in level I trauma centres. 61.3% of the respondents followed a treatment-algorithm. Over 90% used standard laboratory and coagulation tests for decision-making. 56.6% of the respondents declared they additionally used extended coagulation assays (TEG/ROTEM). PRBCs, FFP, platelet concentrates, prothrombin complex concentrates, TXA, calcium, fibrinogen and vitamin K were used by more than 85% of the respondents for the initial treatment of bleeding trauma patients. In all hospitals irrespective of care level the time between patient arrival and administration of the first blood product was less than 30 minutes. Anticoagulants (including NOACs) were identified as an increasing problem in the trauma population (>95%). 65% of the respondents necessitated reliable testing assays for risk stratification. 57.6% required interdisciplinary training programs to improve clinical skills.

CONCLUSION: There is variation in the management of haemorrhage/ coagulopathy across German trauma centres. Though bleeding patients depend on structured procedures, more than a third of the respondents declare they do not follow a treatment algorithm. NOACs are considered as an increasing problem in trauma care.

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