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Systematic reviews are accepted as a robust and less biased means of appraising and synthesizing results from high-quality studies. This report collated and summarized all the systematic review evidence relating to the diagnosis and management of trauma-related coagulopathy and transfusion, thereby covering the widest possible body of literature. We defined 4 key clinical questions: (1) What are the best methods of predicting and diagnosing trauma-related coagulopathy? (2) Which methods of clinical management correct coagulopathy? (3) Which methods of clinical management correct bleeding? and (4) What are the outcomes of transfusion in trauma? Thirty-seven systematic reviews were identified through searches of MEDLINE (1950-July 2010), EMBASE (1980-July 2010), The Cochrane Library (Issue 7, 2010), National Guidelines Clearing House, National Library for Health Guidelines Finder, and UKBTS SRI Transfusion Evidence Library (www.transfusionevidencelibrary.com). The evidence from the systematic review literature was scanty with many gaps, and we were not able to conclusively answer any of our 4 questions. Much more needs to be understood about how coagulopathy and bleeding in trauma are altered by transfusion practices and, most importantly, whether this translates into improved survival. There is a need for randomized controlled trials to answer these questions. The approach described in this report provides a framework for incorporating new evidence.

Original publication

DOI

10.1016/j.tmrv.2011.01.001

Type

Journal article

Journal

Transfusion medicine reviews

Publication Date

07/2011

Volume

25

Pages

217 - 231.e2

Addresses

NHS Blood and Transplant, Oxford Radcliffe Hospitals NHS Trust and University of Oxford, UK. Nicola.Curry@nhsbt.nhs.uk

Keywords

Humans, Blood Coagulation Disorders, Wounds and Injuries, Blood Transfusion, Algorithms, Review Literature as Topic, Practice Guidelines as Topic, Evidence-Based Practice