Timing and Mechanism of Traumatic Coagulopathy
Mitchell Cohen, MD

Background. Trauma remains the leading cause of death and disability in patients less than 40 years old, eclipsing heart attacks, stroke and HIV/AIDS. Problems in clotting resulting in excess bleeding are common following severe trauma and are associated with poor outcome. Unfortunately the mechanisms for these clotting problems are unknown diagnosis is difficult and treatment options are limited. In addition patients who survive with severe trauma and are admitted to the intensive care unit have a higher susceptibility to infection post injury. Despite the understanding of a strong link between injury, bleeding and inflammation, the mechanisms for these abnormalities after trauma are unknown making diagnosis and treatment difficult.

Objective. In this proposal there are two main objectives: (1) to carry out an observational study to determine the incidence and prevalence of clotting abnormalities in severely injured patients and (2) to use systems biology to study the complex biology of these measured proteins to better understand, predict, diagnose and treat bleeding after trauma.

Applicability of the Research Proposal. Uncontrolled hemorrhage to which clotting abnormalities contribute are responsible for the majority of trauma related deaths in the first 24 hours. Vast experience gleaned in civilian and military trauma centers have confirmed that the initial treatment of injured military personnel and civilians must center around a resuscitation protocol that prioritizes control of hemorrhage and abnormal clotting and seeks to prevent the late inflammatory dysfunction. Because bleeding is the most common cause of early death after injury and is associated with worse outcome in patients that survive their initial injury, we believe there is no more pressing topic for research. Indeed this project brings together internationally known researchers with vast civilian and military experience and directly addresses the National Trauma Institute Research Scope. Ultimately this work will help diagnose and treat patients and save lives.