Historical perspective of trauma-induced coagulopathy

Abstract

Injury is the leading cause of death worldwide [1], and the third leading cause of mortality in the United States [2]. Despite advances in emergency medical systems and trauma care, deaths from injury have increased in the United States over the last decade [3]. In both the civilian [4] and military [5] settings, uncontrolled hemorrhage is the leading cause of preventable death after injury. In civilian studies, 80% of deaths from hemorrhage occur within the first 6 h, at a median time of 2.5 h [4]. Consequently, there is intense interest worldwide in the pathogenesis of coagulopathic bleeding after injury and its early management. While there have been substantial insights, the words of Mario Stefanini in his address to the New York Academy of Medicine in 1954 [6] remain applicable today: "The ponderous literature on the subject of hemostasis could perhaps be considered a classical example of the infinite ability of the human mind for abstract speculation. For several years, the number of working theories of the hemostatic mechanisms greatly exceeded and not always respected the confirmed experimental facts. In recent years, however, the revived interest in this field has led to an accumulation of new findings, which has been almost too rapid for their orderly incorporation into a logical working pattern. As a result, we have rapidly gone from a state of orderly ignorance to one of confused enlightenment, from which we have not emerged as yet. ".