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Prevalence and Impact of Admission Acute Traumatic Coagulopathy on Treatment Intensity, Resource Utilization, and Mortality: An Evaluation of 956 Severely Injured Children and Adolescents

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  • Ioannis N Liras
  • Henry W Caplan
  • Jakob Stensballe
  • Charles E Wade
  • Charles S Cox
  • Bryan A Cotton
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INTRODUCTION: Acute coagulopathy of trauma in children are of potential importance to clinical outcome, but knowledge is limited and has only been investigated using conventional coagulation testing (CCT). The purpose of this study was to assess the prevalence and impact of arrival coagulopathy, determined by viscoelastic hemostatic testing, in severely injured children.

METHODS: Pediatric patients (<17 years of age) who were admitted 01/2010-05/2016 and met highest-level trauma activation were included. Patients were divided into two groups (coagulopathy, controls) based on arrival rapid thrombelastography (r-TEG) values. Coagulopathy was defined as the presence of any of the following on r-TEG: ACT ≥128 seconds, α-angle ≤65 degrees, mA ≤55 mm, LY-30 ≥3%. Logistic regression was used to adjust for age, gender, blood pressure, mechanism and injury severity.

RESULTS: 956 patients met inclusion; 507 (57%) were coagulopathic, 449 (43%) were not (non-coagulopathic, control cohort). Coagulopathic patients were younger (median 14 vs. 15) and more likely to be male (68 vs. 60%) and Hispanic (38 vs. 31%); all p<0.05. Coagulopathic patients received more RBC and plasma, had less ICU and ventilator-free days, and higher mortality (12 vs. 3%); all p<0.05. Of these 956, 197 (21%) sustained severe brain injury; 123 (62%) were coagulopathic, 73 (38%) were non-coagulopathic. The mortality difference was even greater for coagulopathic head injuries (31 vs. 10%; p=0002). Adjusting for confounders, admission coagulopathy was an independent predictor of death with an odds ratio of 3.67 (95% C.I. 1.768-7.632; p<0.001).

CONCLUSION: Almost 60% of severely injured children and adolescents arrive with evidence of acute traumatic coagulopathy. The presence of admission coagulopathy is associated with high mortality in children, especially among those with head injuries.

Original languageEnglish
JournalJournal of the American College of Surgeons
Volume224
Issue number4
Pages (from-to)625-632
ISSN1072-7515
DOIs
Publication statusPublished - 25 Jan 2017

ID: 49823733