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trauma program at DHMC, who was not involved with the EICBT
survey. When the test results finally showed that a patient was
suffering from coagulopathy, doctors treated the patient with
blood products. “That’s too slow…you’re often too late,” said
Gupta. The recent wars in Iraq and Afghanistan have taught
doctors that they must act more quickly, making treatment
decisions based on “clinical suspicion” before the lab results
come back. This new paradigm has become more widespread
over the last several years, although understanding and
management of post-traumatic coagulopathy is still inconsistent
throughout the medical community, according to Gupta.
In an effort to increase understanding of coagulopathy,
especially with regard to that critical first hour, a group of trauma
experts formed the EICBT in 2006. The interdisciplinary panel
spans the globe. Novo Nordisk, a Danish foundation that supports
“scientific, humanitarian, and social purposes,” provides the panel
with grant money. In late 2006, the EICBT began to put together
the survey that was published last month. It aimed to assess
worldwide variations in the medical community’s recognition and
management of coagulopathy. Members of the EICBT sent the
survey to colleagues around the world, and 80 people from 25
countries responded.
According to the survey, hospitals in different regions varied
in how they assess whether a patient is suffering from
coagulopathy. Measurements of blood loss, temperature, and pH
are widely used diagnostic factors, but there were significant
variations in the use of rotational thromboelastometry, a special
test that assesses the physical properties of clotting blood.
The early management of injured patients falls under
different people depending on the region. In the Americas, a
surgeon is almost always in charge in the beginning. In Europe
and the Middle East, however, it’s either an anesthesiologist or a
multidisciplinary team. Asian countries also tend to have
multidisciplinary teams in charge at the beginning.
Although these are significant variations in diagnostic tools
and who’s in charge of the patient, they may not be dangerous
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Rachel Leah Blumenthal
Unpublished article for a science journalism graduate course (11/16/08)