Prediction models to advance individualized resuscitation in trauma hemorrhage and acute traumatic coagulopathy (ATC): even the longest journey starts with first steps—Lao-Tzu (Chinese philosopher)

Uncontrolled hemorrhage together with acute traumatic coagulopathy (ATC) are still the principle causes for preventable death following severe injury with one out of four patients admitted to the hospital bleeding with variable signs of laboratory coagulopathy (1-4). Deterioration and death under these conditions usually occur early within 6–8 hours after injury with mortality rates from massive transfusion up to 70 percent even in advanced trauma facilities (5). Meanwhile, ATC is recognized as an own clinical entity with considerable impact on both morbidity and mortality after injury (6). There has been much debate about the potential mechanisms underlying ATC over the past decade but much of the data continues to be rather correlative than causative with robust links and support for diagnosis, prediction and clinical decision making still lacking (7).