The epidemiology and modern management of traumatic hemorrhage: US and international perspectives

David S Kauvar, Charles E Wade, David S Kauvar, Charles E Wade

Abstract

Trauma is a worldwide problem, with severe and wide ranging consequences for individuals and society as a whole. Hemorrhage is a major contributor to the dilemma of traumatic injury and its care. In this article we describe the international epidemiology of traumatic injury, its causes and its consequences, and closely examine the role played by hemorrhage in producing traumatic morbidity and mortality. Emphasis is placed on defining situations in which traditional methods of hemorrhage control often fail. We then outline and discuss modern principles in the management of traumatic hemorrhage and explore developing changes in these areas. We conclude with a discussion of outcome measures for the injured patient within the context of the epidemiology of traumatic injury.

References

    1. Cinat ME, Wilson SE, Lush S, Atkins C. Significant correlation of trauma epidemiology with the economic conditions of a community. Arch Surg. 2004;139:1350–1355. doi: 10.1001/archsurg.139.12.1350.
    1. Peden M, McGee K, Sharma G. The Injury Chart Book: a Graphical Overview of the Global Burden of Injuries. Geneva: World Health Organization; 2002.
    1. Peden M. World Report on Road Traffic Injury Prevention: Summary. Geneva: World Health Organization; 2004.
    1. Krug E, Dahlberg L, Zwi A, Mercy J, Lozano R, Eds. World Report on Violence and Health. Geneva: World Health Organization; 2002.
    1. Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) Atlanta: US Department of Health and Human Services, CDC, National Center for Injury Prevention and Control; 2002.
    1. Centers for Disease Control and Prevention. Medical expenditures attributable to injuries – United States, 2000. MMWR Morb Mortal Wkly Rep. 2004;53:1–4.
    1. Pape HC, Grotz M, Schwermann T, Ruchholtz S, Lefering R, Rieger M, Troger M, Graf von der Schulenburg JM, Krettek C. AG Polytrauma der DGU. The development of a model to calculate the cost of care for the severely injured – an initiative of the Trauma Register of the DGU [in German] Unfallchirurg. 2003;106:348–357. doi: 10.1007/s00113-003-0605-x.
    1. Shackford SR, Mackersie RC, Hoyt DB, Baxt WG, Eastman AB, Hammill FN, Knotts FB, Virgilio RW. Impact of a trauma system on outcome of severely injured patients. Arch Surg. 1987;122:523–527.
    1. Holbrook TL, Anderson JP, Sieber WJ, Browner D, Hoyt DB. Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project. J Trauma. 1999;46:765–771.
    1. Vazquez MG, Rivera FR, Perez AA, Gonzalez CA, Fernandez ME, Navarrete NP. Analysis of quality of life in polytraumatized patients two years after discharge from an intensive care unit. J Trauma. 1996;41:326–332.
    1. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg. 1980;140:144–150. doi: 10.1016/0002-9610(80)90431-6.
    1. Potenza BM, Hoyt DB, Coimbra R, Fortlage D, Holbrook T, Hollingsworth-Fridlund P. The epidemiology of serious and fatal injury in San Diego County over an 11-year period. J Trauma. 2004;56:68–75.
    1. Sauaia A, Moore FA, Moore EE, Moser KS, Brennan R, Read RA, Pons PT. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185–193.
    1. Shackford SR, Mackersie RC, Holbrook TL, Davis JW, Hollingsworth-Fridlund P, Hoyt DB, Wolf PL. The epidemiology of traumatic death. A population-based analysis. Arch Surg. 1993;128:571–575.
    1. Acosta JA, Yang JC, Winchell RJ, Simons RK, Fortlage DA, Hollingsworth-Fridlund P, Hoyt DB. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg. 1998;186:528–533. doi: 10.1016/S1072-7515(98)00082-9.
    1. Stewart RM, Myers JG, Dent DL, Ermis P, Gray GA, Villarreal R, Blow O, Woods B, McFarland M, Garavaglia J. et al.Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention. J Trauma. 2003;54:66–70.
    1. Franklin GA, Boaz PW, Spain DA, Lukan JK, Carrillo EH, Richardson JD. Prehospital hypotension as a valid indicator of trauma team activation. J Trauma. 2000;48:1034–1037.
    1. Heckbert SR, Vedder NB, Hoffman W, Winn RK, Hudson LD, Jurkovich GJ, Copass MK, Harlan JM, Rice CL, Maier RV. Outcome after hemorrhagic shock in trauma patients. J Trauma. 1998;45:545–549.
    1. Durham RM, Moran JJ, Mazuski JE, Shapiro MJ, Baue AE, Flint LM. Multiple organ failure in trauma patients. J Trauma. 2003;55:608–616.
    1. Malone DL, Dunne J, Tracy JK, Putnam AT, Scalea TM, Napolitano LM. Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. J Trauma. 2003;54:898–905.
    1. Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg. 1997;132:620–624.
    1. Sauaia A, Moore FA, Moore EE, Haenel JB, Read RA, Lezotte DC. Early predictors of postinjury multiple organ failure. Arch Surg. 1994;129:39–45.
    1. Hoyt DB, Bulger EM, Knudson MM, Morris J, Ierardi R, Sugerman HJ, Shackford SR, Landercasper J, Winchell RJ, Jurkovich G. Death in the operating room: an analysis of a multi-center experience. J Trauma. 1994;37:426–432.
    1. Mattox KL, Feliciano DV, Moore EE. Trauma. New York: McGraw-Hill, Health Professions Division; 2000.
    1. Ceylan S, Kuzeyli K, Ilbay K, Akturk F. Non operative management of acute extradural hematomas in children. J Neurosurg Sci. 1992;36:85–88.
    1. Mandera M, Zralek C, Krawczyk I, Zycinski A, Wencel T, Bazowski P. Surgery or conservative treatment in children with traumatic intracerebral haematoma. Childs Nerv Syst. 1999;15:267–269. doi: 10.1007/s003810050389.
    1. Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien) 1993;121:100–108. doi: 10.1007/BF01809258.
    1. Wong CW. The CT criteria for conservative treatment – but under close clinical observation – of posterior fossa epidural haematomas. Acta Neurochir (Wien) 1994;126:124–127. doi: 10.1007/BF01476421.
    1. Wong CW. Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta Neurochir (Wien) 1995;135:38–43. doi: 10.1007/BF02187756.
    1. Wong CW. CT and clinical criteria for conservative treatment of supratentorial traumatic intracerebral haematomas. Acta Neurochir (Wien) 1995;135:131–135. doi: 10.1007/BF02187756.
    1. Mina AA, Knipfer JF, Park DY, Bair HA, Howells GA, Bendick PJ. Intracranial complications of preinjury anticoagulation in trauma patients with head injury. J Trauma. 2002;53:668–672.
    1. Mina AA, Bair HA, Howells GA, Bendick PJ. Complications of preinjury warfarin use in the trauma patient. J Trauma. 2003;54:842–847.
    1. Chen L, Bracey AW, Radovancevic R, Cooper JR Jr, Collard CD, Vaughn WK, Nussmeier NA. Clopidogrel and bleeding in patients undergoing elective coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2004;128:425–431. doi: 10.1016/j.jtcvs.2004.02.019.
    1. Englberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T. Impact of clopidogrel in coronary artery bypass grafting. Eur J Cardiothorac Surg. 2004;26:96–101. doi: 10.1016/j.ejcts.2004.03.030.
    1. Slappendel R, Weber EW, Benraad B, Dirksen R, Bugter ML. Does ibuprofen increase perioperative blood loss during hip arthroplasty? Eur J Anaesthesiol. 2002;19:829–831.
    1. Demetriades D, Constantinou C, Salim A, Velmahos G, Rhee P, Chan L. Liver cirrhosis in patients undergoing laparotomy for trauma: effect on outcomes. J Am Coll Surg. 2004;199:538–542. doi: 10.1016/j.jamcollsurg.2004.06.017.
    1. Tinkoff G, Rhodes M, Diamond D, Lucke J. Cirrhosis in the trauma victim. Effect on mortality rates. Ann Surg. 1990;211:172–177.
    1. Rubin R, Rand ML. Alcohol and platelet function. Alcohol Clin Exp Res. 1994;18:105–110.
    1. Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma. 2003;54:1127–1130.
    1. Lynn M, Jeroukhimov I, Klein Y, Martinowitz U. Updates in the management of severe coagulopathy in trauma patients. Intensive Care Med. 2002;28(suppl 2):S241–S247. doi: 10.1007/s00134-002-1471-7.
    1. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003;55:39–44.
    1. Ferrara A, MacArthur JD, Wright HK, Modlin IM, McMillen MA. Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg. 1990;160:515–518.
    1. Staab DB, Sorensen VJ, Fath JJ, Raman SB, Horst HM, Obeid FN. Coagulation defects resulting from ambient temperature-induced hypothermia. J Trauma. 1994;36:634–638.
    1. Cosgriff N, Moore EE, Sauaia A, Kenny-Moynihan M, Burch JM, Galloway B. Predicting life-threatening coagulopathy in the massively transfused trauma patient: hypothermia and acidoses revisited. J Trauma. 1997;42:857–861.
    1. Ferrara A, MacArthur JD, Wright HK, Modlin IM, McMillen MA. Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg. 1990;160:515–518.
    1. Watts DD, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma. 1998;44:846–854.
    1. Shackford SR, Hollingworth-Fridlund P, Cooper GF, Eastman AB. The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma. 1986;26:812–820.
    1. West JG, Trunkey DD, Lim RC. Systems of trauma care. A study of two counties. Arch Surg. 1979;114:455–460.
    1. Arreola-Risa C, Mock CN, Lojero-Wheatly L, de la CO, Garcia C, Canavati-Ayub F, Jurkovich GJ. Low-cost improvements in pre-hospital trauma care in a Latin American city. J Trauma. 2000;48:119–124.
    1. Benitez FL, Pepe PE. Role of the physician in prehospital management of trauma: North American perspective. Curr Opin Crit Care. 2002;8:551–558. doi: 10.1097/00075198-200212000-00012.
    1. Dick WF. Anglo-American vs. Franco-German emergency medical services system. Prehospital Disaster Med. 2003;18:29–35.
    1. Ummenhofer W, Scheidegger D. Role of the physician in pre-hospital management of trauma: European perspective. Curr Opin Crit Care. 2002;8:559–565. doi: 10.1097/00075198-200212000-00013.
    1. American College of Surgeons. Committee on Trauma. PHTLS: Basic and Advanced Prehospital Trauma Life Support. Chicago: American College of Surgeons; 2003.
    1. American College of Surgeons. ATLS, Advanced Trauma Life Support. Chicago, IL: The College; 2004.
    1. Cannon W, Fraser J, Cowell E. The preventive treatment of wound shock. JAMA. 1918. pp. 618–621.
    1. Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, Mattox KL. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331:1105–1109. doi: 10.1056/NEJM199410273311701.
    1. Burris D, Rhee P, Kaufmann C, Pikoulis E, Austin B, Eror A, DeBraux S, Guzzi L, Leppaniemi A. Controlled resuscitation for uncontrolled hemorrhagic shock. J Trauma. 1999;46:216–223.
    1. Capone AC, Safar P, Stezoski W, Tisherman S, Peitzman AB. Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock. J Am Coll Surg. 1995;180:49–56.
    1. Kowalenko T, Stern S, Dronen S, Wang X. Improved outcome with hypotensive resuscitation of uncontrolled hemorrhagic shock in a swine model. J Trauma. 1992;33:349–353.
    1. Mapstone J, Roberts I, Evans P. Fluid resuscitation strategies: a systematic review of animal trials. J Trauma. 2003;55:571–589.
    1. Sondeen JL, Coppes VG, Holcomb JB. Blood pressure at which rebleeding occurs after resuscitation in swine with aortic injury. J Trauma. 2003;54:S110–S117.
    1. Stern SA. Low-volume fluid resuscitation for presumed hemorrhagic shock: helpful or harmful? Curr Opin Crit Care. 2001;7:422–430. doi: 10.1097/00075198-200112000-00009.
    1. Deb S, Martin B, Sun L, Ruff P, Burris D, Rich N, DeBreux S, Austin B, Rhee P. Resuscitation with lactated Ringer's solution in rats with hemorrhagic shock induces immediate apoptosis. J Trauma. 1999;46:582–588.
    1. Deb S, Sun L, Martin B, Talens E, Burris D, Kaufmann C, Rich N, Rhee P. Lactated ringer's solution and hetastarch but not plasma resuscitation after rat hemorrhagic shock is associated with immediate lung apoptosis by the up-regulation of the Bax protein. J Trauma. 2000;49:47–53.
    1. Rhee P, Koustova E, Alam HB. Searching for the optimal resuscitation method: recommendations for the initial fluid resuscitation of combat casualties. J Trauma. 2003;54:S52–S62.
    1. Mattox KL, Maningas PA, Moore EE, Mateer JR, Marx JA, Aprahamian C, Burch JM, Pepe PE. Prehospital hypertonic saline/dextran infusion for post-traumatic hypotension. The U.S.A. Multicenter Trial. Ann Surg. 1991;213:482–491.
    1. Boldt J. Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can J Anaesth. 2004;51:500–513.
    1. Protheroe R, Nolan J. Which fluid to give? Trauma. 2001;3:151–160. doi: 10.1191/146040801717155541.
    1. Rizoli SB. Crystalloids and colloids in trauma resuscitation: a brief overview of the current debate. J Trauma. 2003;54:S82–S88.
    1. Whinney RR, Cohn SM, Zacur SJ. Fluid resuscitation for trauma patients in the 21st century. Curr Opin Crit Care. 2000;6:395–400. doi: 10.1097/00075198-200012000-00004.
    1. Greenburg AG, Kim HW. Hemoglobin-based oxygen carriers. Crit Care. 2004;8(Suppl 2):S61–S64. doi: 10.1186/cc2455.
    1. Proctor KG. Blood substitutes and experimental models of trauma. J Trauma. 2003;54:S106–S109.
    1. Tisherman SA, Barie P, Bokhari F, Bonadies J, Daley B, Diebel L, Eachempati SR, Kurek S, Luchette F, Carlos PJ. et al.Clinical practice guideline: endpoints of resuscitation. J Trauma. 2004;57:898–912.
    1. Reed RL, Johnson TD, Hudson JD, Fischer RP. The disparity between hypothermic coagulopathy and clotting studies. J Trauma. 1992;33:465–470.
    1. Kaufmann CR, Dwyer KM, Crews JD, Dols SJ, Trask AL. Usefulness of thromboelastography in assessment of trauma patient coagulation. J Trauma. 1997;42:716–720.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj