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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
Insights
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.
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.
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.
Objectives:
To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma.
Methods:
We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was > or =1.2 or partial thromboplastin time (PTT) was > or =33.0 seconds and markedly elevated if the INR was > or =1.5 or PTT was > or =40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies.
Results:
A total of 1082 patients' records were reviewed, and the 830 (77%) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6%) of these were found to be markedly elevated. In the multivariate analysis, a GCS < or =13 (odds ratio [OR] 8.7, 95% confidence interval [CI] 4.3, 17.7), low systolic blood pressure (OR 4.0, 95% CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies.
Conclusion:
Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS < or =13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.
