Simplified treatment algorithm for the management of trauma-induced hemorrhage without viscoelastic testing

Abstract

Uncontrolled bleeding after major trauma remains a significant cause of death, with up to a third of trauma patients presenting with signs of coagulopathy at hospital admission. Rapid correction of coagulopathy is therefore vital to improve mortality rates and patient outcomes in this population. Early and repeated monitoring of coagulation parameters followed by clear protocols to correct hemostasis is the recommended standard of care for bleeding trauma patients. However, although a number of treatment algorithms are available, these are frequently complex and can rely on the use of viscoelastic testing, which is not available in all treatment centers. We therefore set out to develop a concise and pragmatic algorithm to guide treatment of bleeding trauma patients without the use of point-of-care viscoelastic testing. The algorithm we present here is based on published guidelines and research, includes recommendations regarding treatment and dosing, and is simple and clear enough for even an inexperienced physician to follow. In this way, we have demonstrated that treatment protocols can be developed and adapted to the resources available, to offer clear and relevant guidance to the entire trauma team.

Keywords: algorithm; hemorrhage; hemostasis; multiple trauma.

Figure 1

Simplified treatment algorithm for the management of trauma-related bleeding without the use of viscoelastic testing. The algorithm consists of two parts: (A) a checklist to guide assessment and treatment of the patient and (B) a decision tree to guide administration of hemostatic agents.