Point-of-Care Coagulation Monitoring in Trauma Patients

Trauma remains one of the major causes of death and disability all over the world. Uncontrolled blood loss and trauma-induced coagulopathy represent preventable causes of trauma-related morbidity and mortality. Treatment may consist of allogeneic blood product transfusion at a fixed ratio or in an individualized goal-directed way based on point-of-care (POC) and routine laboratory measurements. Viscoelastic POC measurement of the developing clot in whole blood and POC platelet function testing allow rapid and tailored coagulation and transfusion treatment based on goal-directed, factor concentrate–based algorithms. The first studies have been published showing that this concept reduces the need for allogeneic blood transfusion and improves outcome. This review highlights the concept of goal-directed POC coagulation management in trauma patients, introduces a selection of POC devices, and presents algorithms which allow a reduction in allogeneic blood product transfusion and an improvement of trauma patient outcome.

Optimal Use of Blood Products in Severely Injured Trauma Patients

Injury is the leading cause of life years lost in the United States, and uncontrolled hemorrhage is the leading cause of potentially preventable death. Traditionally, these patients have been serially resuscitated with large volumes of crystalloid and/or colloids and red blood cells, followed by smaller amounts of plasma and platelets. Transfusion data coming first from the ongoing war in Iraq and Afghanistan and followed by multiple civilian studies have brought into question this tradition-based practice. Numerous recent retrospective single and multicenter studies have associated improved outcomes with earlier and increased use of plasma and platelets. These data have stimulated significant interest in studying massively transfused trauma patients. Most clinicians have concluded that the optimal timing and quantity of blood products in the treatment of hypothermic, coagulopathic, and acidotic trauma patients are unclear. Although there are strongly held opinions and long-standing traditions in their use, there are little quality data within which to logically guide resuscitation therapy. A multicenter prospective observational study is ongoing, and randomized trials are planned. This review will address the issues raised previously and describe recent trauma patient outcome data utilizing predetermined plasma:platelet:red blood cell transfusion ratios, and possibilities for future transfusion products and research.

The Effects of Methamphetamine Use on Trauma Patient Outcome

A retrospective review was conducted to analyze the effect of methamphetamine use in trauma patients. Charts of all trauma patients admitted to Kern Medical Center from January 1, 2003, to January 5, 2006 (36 months) were analyzed for length of stay, intensive care unit (ICU) admission rate and number of ICU days, ventilator days, and mortality. Results were compared in patients testing positive for methamphetamine (M+) with those who tested negative (M-). Data were then stratified according to six Injury Severity Score (ISS) groups: 1–5, 6–10, 11–15, 16–20, 21–25, and 26–30. A total of 4759 patients were admitted to the trauma unit, 971 of whom had available urine toxicology results. Six hundred seventy-four tested M- and 297 tested M+. There were no differences in total ICU days or ventilator days in the M+ versus M- patients. There was a higher incidence of assault in the M+ group ( P = 0.0001). A trend toward decreased mortality was noted in M+ patients ( P = 0.0778). ISS subset analysis demonstrated an increased ICU admission rate in M+ patients in ISS group 1–5 ( P = 0.0002). There was also an increased length of stay in M+ patients within the ISS 6–10 group (8 versus 5 days, respectively, P = 0.015).