Fröhlich Matthias, Mutschler Manuel, Caspers Michael, Nienaber Ulrike, Jäcker Vera, Driessen Arne, Bouillon Bertil, Maegele Marc
Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimerstr.200, 51109, Cologne, Germany.
Institute for Research in Operative Medicine (IFOM), Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Ostmerheimerstr.200, 51109, Cologne, Germany.
Eur J Trauma Emerg Surg. 2019 Feb;45(1):115-124. doi: 10.1007/s00068-017-0884-5. Epub 2017 Nov 23.
Over the last decade, the pivotal role of trauma-induced coagulopathy has been described and principal drivers have been identified. We hypothesized that the increased knowledge on coagulopathy of trauma would translate into a more cautious treatment, and therefore, into a reduced overall incidence rate of coagulopathy upon ER admission.
Between 2002 and 2013, 61,212 trauma patients derived from the TraumaRegister DGU® had a full record of coagulation parameters and were assessed for the presence of coagulopathy. Coagulopathy was defined by a Quick's value < 70% and/or platelet counts < 100,000/µl upon ER admission. For each year, the incidence of coagulopathy, the amount of pre-hospital administered i.v.-fluids and transfusion requirements were assessed.
Coagulopathy upon ER admission was present in 24.5% of all trauma patients. Within the years 2002-2013, the annual incidence of coagulopathy decreased from 35 to 20%. Even in most severely injured patients (ISS > 50), the incidence of coagulopathy was reduced by 7%. Regardless of the injury severity, the amount of pre-hospital i.v.-fluids declined during the observed period by 51%. Simultaneously, morbidity and mortality of severely injured patients were on the decrease.
During the 12 years observed, a substantial decline of coagulopathy has been observed. This was paralleled by a significant decrease of i.v.-fluids administered in the pre-hospital treatment. The reduced presence of coagulopathy translated into decreased transfusion requirements and mortality. Nevertheless, especially in the most severely injured patients, posttraumatic coagulopathy remains a frequent and life-threatening syndrome.
在过去十年中，创伤性凝血病的关键作用已被描述，其主要驱动因素也已确定。我们假设，对创伤性凝血病认识的增加将转化为更谨慎的治疗，从而降低急诊入院时凝血病的总体发病率。
2002年至2013年期间，来自创伤登记数据库DGU®的61212例创伤患者有完整的凝血参数记录，并对凝血病的存在情况进行了评估。凝血病的定义为急诊入院时Quick值<70%和/或血小板计数<100000/µl。每年评估凝血病的发病率、院前静脉输液量和输血需求。
所有创伤患者中，24.5%在急诊入院时存在凝血病。在2002年至2013年期间，凝血病的年发病率从35%降至20%。即使在伤势最严重的患者（损伤严重度评分>50）中，凝血病的发病率也降低了7%。无论损伤严重程度如何，观察期间院前静脉输液量下降了51%。同时，重伤患者的发病率和死亡率也在下降。
在观察的12年中，凝血病显著减少。这与院前治疗中静脉输液量的显著减少相平行。凝血病的减少转化为输血需求和死亡率的降低。然而，尤其是在伤势最严重的患者中，创伤后凝血病仍然是一种常见且危及生命的综合征。
