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The utility of routine trauma laboratories in pediatric trauma resuscitations
Martin S Keller1, C Eric Coln, Jennifer A Trimble
1Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, St. Louis, MO 63104, USA. Kellerms@slu.edu
Insights
Screening blood tests for injured children have limited value. Abnormalities in coagulation panels correlated with intracranial injury, but routine labs rarely led to interventions.
Area of Science:
- Pediatric Trauma Care
- Clinical Pathology
- Emergency Medicine
Background:
- Evaluating injured children presents challenges.
- Screening blood tests are often recommended for pediatric trauma patients.
Purpose of the Study:
- To assess the utility of routine resuscitation blood tests in injured children.
- To determine the frequency of abnormalities, correlation with injury, and impact on management and outcomes.
Main Methods:
- Retrospective review of resuscitation blood tests (complete blood count, chem12, coagulation panel, urinalysis) in 240 children (<16 years) meeting trauma criteria.
- Analysis of abnormality frequency, injury correlation, interventions, and patient outcomes.
Main Results:
- Abnormalities were common, particularly in glucose (77%), white blood cell count (41%), aspartate aminotransferase (43%), and alanine transferase (35%).
- Organ-specific chemistries showed poor injury prediction, except transaminasemia >400 U/L with liver injury.
- Coagulation abnormalities correlated with intracranial injury and lower Glasgow Coma Scale scores (GCS).
Conclusions:
- Routine laboratory panels provide limited value in the management of injured children.
- Interventions based on routine test abnormalities were infrequent (10%).
Background:
Because of the difficulties in evaluating injured children, screening blood tests are recommended.
Methods:
Resuscitation blood tests (complete blood count, chem12, coagulation panel, urinalysis) were reviewed for abnormality frequency, injury correlation, managements, and outcome.
Results:
Panels were obtained on 240 children (age < 16 years) meeting trauma system criteria. Abnormalities were identified as follows: white blood cell/hematocrit/platelets (41%, 27%, 1%), Na/K/Cl/CO(2) (3%, 30%, 23%, 14%), blood ureal nitrogen/creatinine (6%, 0%), prothrombin time/international normalized ratio/partial thromboplastin time (22%, 16%, 6%), aspartate aminotransferase/alanine transferase (43%, 35%), amylase (2%), glucose (77%), and urinalysis (31%). Organ-specific chemistries predicted injury poorly. Transaminasemia correlated with liver injury when levels exceeded 400 U/L. Two children (1%) with hyperamylasemia had abdominal injuries. Coagulation abnormalities correlated with intracranial injury (43%) and Glasgow Coma Scale (GCS 3 to 8; 56%, GCS 9 to 14; 20%, GCS 15; 14%, P <0.05). Only 25 (10%) had interventions for test abnormalities (11 transfusions, 8 fresh frozen plasma, 3 tests repeated, 3 KCl).
Conclusions:
Routine laboratory panels are little value in the management of injured children.
