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Updated: May 29, 2026
Microfluidics in Assessing Platelet Function
Published on: November 8, 2024
Coagulopathy is prevalent and associated with adverse outcomes in transfused pediatric trauma patients
Jeanne E Hendrickson1, Beth H Shaz, Greg Pereira
1Aflac Cancer Center and Blood Disorders Service, Children's Healthcare of Atlanta, Division of Pediatric Hematology/Oncology, Emory University School of Medicine, Atlanta, GA, USA. eanne.hendrickson@choa.org
Insights
Coagulopathy, or impaired blood clotting, is common in critically injured children requiring transfusions and significantly increases their risk of death. Early intervention may improve outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Trauma Critical Care
- Hematology
Background:
- Coagulopathy is a significant concern in trauma patients.
- Early identification of coagulopathy is crucial for patient management.
Purpose of the Study:
- To assess coagulopathy in pediatric trauma patients upon emergency department presentation.
- To determine the association between coagulopathy and mortality in this population.
Main Methods:
- Retrospective analysis of 102 pediatric trauma patients requiring blood transfusion within 24 hours.
- Evaluation of coagulation parameters (prothrombin time, partial thromboplastin time, fibrinogen, hemoglobin, platelet count) on emergency department arrival.
- Correlation of coagulation values with clinical data and patient outcomes, including mortality.
Main Results:
- Abnormal prothrombin time (72%), partial thromboplastin time (38%), fibrinogen (52%), hemoglobin (58%), and platelet count (23%) were observed.
- Abnormal prothrombin time, partial thromboplastin time, and platelet count were significantly associated with mortality (P=.005, .001, <.0001, respectively).
- These associations remained significant in multivariate analysis, independent of injury severity.
Conclusions:
- Coagulopathy is highly prevalent in severely injured pediatric trauma patients needing transfusions.
- Impaired coagulation is a strong predictor of mortality in pediatric trauma.
- Further research is warranted on early coagulation factor replacement and massive transfusion protocols to improve outcomes.
Objective:
To evaluate coagulopathy in pediatric trauma patients on presentation to the emergency department, and to quantify the relationship with mortality.
Study Design:
Pediatric trauma patients requiring a blood transfusion (red blood cells, fresh frozen plasma, platelets, or cryoprecipitate) within 24 hours of arrival were included. Coagulation values on emergency department arrival were analyzed, as were clinical details and outcome.
Results:
A total of 102 children (mean age, 6 years; mean injury severity score 22, mean Glascow Coma Scale 7, 80% blunt trauma victims) were studied over a 4 year period. An abnormal prothrombin time was found in 72%, partial thromboplastin time in 38%, fibrinogen in 52%, hemoglobin in 58%, and platelet count in 23%. An abnormal prothrombin time, partial thromboplastin time, and platelet count were strongly associated with mortality (P=.005, .001, and <.0001, respectively) and remained significantly associated in multivariate analysis after adjusting for injury severity score.
Conclusions:
Coagulopathy is prevalent in pediatric trauma patients ill enough to require a transfusion and is strongly associated with mortality. Studies are needed to determine whether early coagulation factor replacement and the institution of massive transfusion protocols may improve outcomes in these patients.
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