Coagulopathy and shock on admission is associated with mortality for children with traumatic injuries at combat support hospitals
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Published on: November 20, 2016
Jason T Patregnani1, Matthew A Borgman, Marc Maegele
1Connecticut Children's Medical Center, Hartford, CT, USA. Jpatregnani@gmail.com
Insights
Early coagulopathy and shock in pediatric trauma patients are common and independently increase mortality risk. Prompt identification and treatment are crucial for improving outcomes in children with traumatic injuries.
Area of Science:
- Trauma Surgery
- Pediatric Critical Care
- Coagulation Disorders
Background:
- Early coagulopathy and shock are independently linked to mortality in adult trauma patients.
- Limited data exist on the incidence and outcomes associated with early coagulopathy and shock in pediatric trauma.
- This study addresses the knowledge gap concerning pediatric traumatic injuries.
Purpose of the Study:
- To determine if coagulopathy and shock on admission are independently associated with mortality in pediatric trauma patients.
- To investigate the incidence of these conditions in young trauma survivors.
- To establish the independent impact of coagulopathy and shock on pediatric mortality.
Main Methods:
- Retrospective review of the Joint Theater Trauma Registry (2002-2009).
- Inclusion of pediatric patients (<18 years) with complete data on Injury Severity Score, international normalized ratio (INR), base deficit, and mortality.
- Coagulopathy defined as INR ≥1.5; shock defined as base deficit ≥6. Analysis using univariate and multivariate logistic regression.
Main Results:
- The incidence of early coagulopathy was 27%, and shock was 38.3%.
- Coagulopathy was associated with 22% mortality, and shock with 16.8% mortality.
- Multivariate analysis showed independent associations: coagulopathy (OR 2.2), shock (OR 3.0), and both (OR 3.8) with inhospital mortality.
Conclusions:
- Coagulopathy and shock are common in pediatric trauma patients admitted to combat support hospitals.
- These conditions are independently associated with a significantly higher risk of inhospital mortality.
- Further research is needed to explore rapid diagnostic methods and early goal-directed treatments for pediatric trauma patients.
Objective:
In adults, early traumatic coagulopathy and shock are both common and independently associated with mortality. There are little data regarding both the incidence and association of early coagulopathy and shock on outcomes in pediatric patients with traumatic injuries. Our objective was to determine whether coagulopathy and shock on admission are independently associated with mortality in children with traumatic injuries.
Methods:
A retrospective review of the Joint Theater Trauma Registry from U.S. combat support hospitals in Iraq and Afghanistan from 2002 to 2009 was performed. Coagulopathy was defined as an international normalized ratio of ≥1.5 and shock as a base deficit of ≥6. Laboratory values were measured on admission. Primary outcome was inhospital mortality. Univariate analyses were performed on all admission variables followed by reverse stepwise multivariate logistic regression to determine independent associations.
Setting:
Combat support hospitals in Iraq and Afghanistan.
Patients:
Patients <18 yrs of age with Injury Severity Score, international normalized ratio, base deficit, and inhospital mortality were included. Of 1998 in the cohort, 744 (37%) had a complete set of data for analysis.
Intervention:
None.
Measurements And Main Results:
The incidence of early coagulopathy and shock were 27% and 38.3% and associated with mortality of 22% and 16.8%, respectively. After multivariate logistic regression, early coagulopathy had an odds ratio of 2.2 (95% confidence interval 1.1-4.5) and early shock had an odds ratio of 3.0 (95% confidence interval 1.2-7.5) for mortality. Patients with coagulopathy and shock had an odds ratio of 3.8 (95% confidence interval 2.0-7.4) for mortality.
Conclusions:
In children with traumatic injuries treated at combat support hospitals, coagulopathy and shock on admission are common and independently associated with a high incidence of inhospital mortality. Future studies are needed to determine whether more rapid and accurate methods of measuring coagulopathy and shock as well as if early goal-directed treatment of these states can improve outcomes in children.
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