• M Maegele.
• Department of Trauma and Orthopedic Surgery, University of Witten/Herdecke, Cologne-Merheim Medical Center, Cologne, Germany. Marc.Maegele@t-online.de
• Vox Sang. 2009 Jul 1;97(1):39-49.

BackgroundUncontrolled haemorrhage is still responsible for more than 50% of all trauma-related deaths within the first 48 h after hospital admission. Clinical observations together with recent research resulted in a new appreciation of the central role of coagulopathy in acute trauma care. A synopsis of different analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU)/German Society of Trauma Surgery) with respect to incidence, risk stratification and therapeutic management of acute post-traumatic coagulopathy is presented.MethodsRetrospective analyses based on datasets from severely multiple-injured patients derived from the TR-DGU database and development/validation of a scoring system (TASH score = trauma-associated severe haemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life-threatening haemorrhage after severe multiple injuries.Results/ConclusionThere is a high frequency of acute post-traumatic coagulopathy already present upon ER admission which is associated with significant morbidity and mortality in multiple-injured patients. The TASH score is recognized as an easy-to-calculate and valid scoring system to predict the individual's probability for massive transfusion and thus ongoing life-threatening haemorrhage at a very early stage after severe multiple injuries. An early aggressive management of acute post-traumatic coagulopathy including a more balanced administration of blood products to favour improved outcome is advocated.

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