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Coagulation testing in pediatric blunt trauma patients.

J F Holmes1, H C Goodwin, C Land

  • 1Division of Emergency Medicine, Department of Internal Medicine, University of California, Davis, School of Medicine, Sacramento, California 95817-2282, USA. jfholmes@ucdavies.edu

Pediatric Emergency Care
|October 24, 2001
PubMed
Summary

Pediatric blunt trauma patients often have minor coagulation abnormalities. Marked elevations in coagulation studies are infrequent but linked to lower Glasgow Coma Scale scores, low blood pressure, fractures, and severe wounds.

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Area of Science:

  • Pediatric Emergency Medicine
  • Trauma Surgery
  • Hematology

Background:

  • Abnormal coagulation studies are common in pediatric blunt trauma.
  • Identifying factors associated with severe coagulation abnormalities is crucial for patient management.

Purpose of the Study:

  • Determine the prevalence of abnormal coagulation studies in pediatric blunt trauma patients.
  • Identify variables associated with markedly elevated coagulation studies.

Main Methods:

  • Retrospective review of medical records for pediatric patients (<15 years) with blunt head or torso trauma.
  • Defined elevated coagulation studies as INR > or =1.2 or PTT > or =33.0 seconds, and markedly elevated as INR > or =1.5 or PTT > or =40 seconds.
  • Used logistic regression to identify independent predictors of markedly elevated coagulation studies.

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Main Results:

  • 830 patients were included; 28% had elevated coagulation studies, and 6% had markedly elevated studies.
  • Markedly elevated coagulation studies were independently associated with Glasgow Coma Scale (GCS) < or =13 (OR 8.7), low systolic blood pressure (OR 4.0), open/multiple bony fractures (OR 2.9), and major tissue wounds (OR 2.8).

Conclusions:

  • Minor elevations in coagulation studies are frequent in hospitalized pediatric blunt trauma patients.
  • Marked elevations are infrequent but significantly associated with indicators of severe trauma, including neurological compromise, hemodynamic instability, and extensive injuries.