Trauma initial evaluation
Also known as: ATLS · primary survey · trauma survey
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Advanced Trauma Life Support (ATLS), 11th Edition
American College of Surgeons (ACS) · 2025 · 11th edition
The ACS's standardized program and course manual for the initial assessment and resuscitation of injured patients, released in its 11th edition in 2025 after a redesign involving more than 200 experts from over 20 countries.
The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition
Task Force for Advanced Bleeding Care in Trauma (ESAIC, ESICM, ESS, ESTES, EuSEM, NATA) · 2023 · 6th edition
The pan-European multidisciplinary guideline advising clinicians on the initial diagnostic and therapeutic management of the bleeding trauma patient, published open access in Critical Care in 2023 as an update of the previous edition.
- It contains 39 clinical practice recommendations arranged along the approximate temporal path of managing a bleeding trauma patient. source
- The task force includes representatives of six European professional societies spanning anaesthesia and intensive care, shock, trauma and emergency surgery, emergency medicine, and patient blood management. source
US vs EU key differences
- The 11th edition of ATLS changed the primary survey mnemonic to xABCDE, formally placing control of exsanguinating haemorrhage ahead of airway management. source
- The two documents are not like-for-like: ATLS is a course-based, whole-patient initial assessment framework, while the European document is a set of 39 GRADE-based recommendations confined to major bleeding and coagulopathy, sequenced along the temporal path of the bleeding trauma patient. source
- The European guideline attaches explicit numeric targets to resuscitation: systolic blood pressure 80–90 mmHg until bleeding is controlled in patients without brain injury, mean arterial pressure of at least 80 mmHg when the Glasgow Coma Scale is 8 or lower, and a haemoglobin transfusion target of 70–90 g/L. source
- The European guideline names noradrenaline as the vasopressor of choice when restricted fluid resuscitation fails to reach the blood pressure target, and dobutamine when myocardial dysfunction is present. source
What changed recently
- US10th edition → 11th edition2025-01-01
ATLS 11 shifts the primary survey to an xABCDE sequence that puts control of exsanguinating haemorrhage ahead of the airway, and moves to balanced resuscitation with early 1:1:1 blood component therapy rather than crystalloid-led volume replacement. Glasgow Coma Scale assessment changes from the 10th edition's single total score to combined component and trend scoring, with new emphasis on recognising herniation and preventing secondary brain injury from the primary survey onward.
source ↗curation confidence 90% - EU5th edition (2019) → 6th edition2023-03-01
The sixth edition condenses the guideline into 39 recommendations grouped behind key decision points along the bleeding patient's timeline, citing only the highest-quality evidence rather than an exhaustive literature review as earlier editions did. Clinically it takes an explicitly neutral position on prehospital blood product transfusion, advises against routine point-of-care platelet function testing, and retains restrictive volume replacement targeting a systolic pressure of 80-90 mmHg until bleeding is controlled.
source ↗curation confidence 90%
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